为了比较在门诊和住院环境中进行的相同外科手术,以确定与此选择相关的人口统计信息,30天重访率的差异,以及30天护理的总费用。
回顾性队列分析。
佛罗里达州的门诊和住院中心,纽约,和马里兰州。
医疗保健成本和利用项目,国家门诊手术和服务数据库,和州住院患者数据库用于确定2016年接受耳鼻咽喉科常规手术的患者.国家急诊科数据库和国家住院患者数据库用于识别30天的重诊。
共有55,311例患者接受了耳鼻喉手术:51,136例(92.4%)门诊和4175例(7.6%)住院。黑人患者在门诊接受护理的调整后几率显着降低(赔率比,0.69[95%CI,0.55-0.85];P=.001)和非特定其他种族(赔率比,与白人患者相比,0.71[95%CI,0.52-0.95];P=.001)。女性在非卧床环境中接受手术的校正几率高1.16(95%CI,1.05-1.29;P=0.005)。在头颈部手术的分类中,保险状况和收入与护理地点相关。调整后的住院手术费用明显高于门诊(中位数,59,112美元对14,899美元);住院手术的30天调整后费用为71,333.07美元(95%CI,56,223.99美元-86,42.15美元;P<.001),与门诊手术相比,住院手术的费用更高;调整后的30天重诊几率是所有手术的2.23倍(95%CI,1.44-3.44;P<.001)。
使用非卧床设置提供耳鼻喉手术存在差异。需要进行额外的研究,以确保手术护理环境的公平分类。
To compare the same surgical procedure performed in ambulatory and inpatient settings to determine the demographics associated with this selection, the differences in 30-day revisit rates, and the total 30-day cost of care.
Retrospective cohort analysis.
Ambulatory and inpatient centers in Florida, New York, and Maryland.
The Healthcare Cost and Utilization Project, the State Ambulatory Surgery and Services Database, and the State Inpatient Database were used to identify patients undergoing commonly performed otolaryngologic procedures in 2016. The State Emergency Department Database and State Inpatient Database were used to identify 30-day revisits.
A total of 55,311 patients underwent an otolaryngologic procedure: 51,136 (92.4%) ambulatory and 4175 (7.6%) inpatient. Adjusted odds of receiving care in the ambulatory setting was significantly lower for Black patients (odds ratio, 0.69 [95% CI, 0.55-0.85]; P = .001) and nonspecified other races (odds ratio, 0.71 [95% CI, 0.52-0.95]; P = .001) as compared with White patients. Women had 1.16-higher adjusted odds of undergoing a procedure in the ambulatory setting (95% CI, 1.05-1.29; P = .005). Insurance status and income were associated with location of care in the subcategorization of head and neck surgery. Adjusted inpatient procedure costs were significantly more than ambulatory (median, $59,112 vs $14,899); 30-day adjusted costs were $71,333.07 (95% CI, $56,223.99-$86,42.15; P < .001) more expensive for inpatient procedures vs ambulatory; and the adjusted 30-day odds of revisit were 2.23 times greater (95% CI, 1.44-3.44; P < .001) for ambulatory surgery across all procedures.
Disparities exist in the use of ambulatory settings to provide otolaryngologic surgery. Additional research is required to ensure equitable triaging of surgical care setting.