Causation Not Correlation: Simple Mediation Analysis of Amputation Costs

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-05-14 DOI:10.1016/j.jss.2025.04.008

Johnathan V. Torikashvili BS , Meagan D. Read MD , Rajavi Parikh DO , Tyler Zander MD , Melissa Kendall MD , Emily A. Grimsley MD , Paul C. Kuo MD, MS, MBA, FACS

{"title":"Causation Not Correlation: Simple Mediation Analysis of Amputation Costs","authors":"Johnathan V. Torikashvili BS , Meagan D. Read MD , Rajavi Parikh DO , Tyler Zander MD , Melissa Kendall MD , Emily A. Grimsley MD , Paul C. Kuo MD, MS, MBA, FACS","doi":"10.1016/j.jss.2025.04.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic significantly impacted health-care delivery and hospital financials. This study aims to identify the pandemic's effects on costs associated with nonelective major lower extremity amputation (LEA) and mediating factors influencing this cost.</div></div><div><h3>Methods</h3><div>The 2019-2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent nonelective LEA. Patient inflation-adjusted costs were collected. Florida COVID-19 mortality rates established 9-month COVID-heavy (CH) and COVID-light (CL) timeframes, compared to a 9-month pre-COVID (PC; 2019) timeframe. Simple mediation analysis with 2000 bootstrapping interactions evaluated patient comorbidity, surgical complications, and hospital treatment factors as potential mediators on cost.</div></div><div><h3>Results</h3><div>A total of 5963 patients were included (1957 PC, 1994 CH, 2012 CL). Compared to PC, COVID timeframes had significantly increased total (+7.8%), hospital (+14.5%), intensive care unit (+14.3%), and operating room (+14.9%) costs. Simple mediation analysis identified potential influencers of increased cost: (1) acute kidney injury during CL (<em>P</em> = 0.03), (2) sepsis during CL (<em>P</em> = 0.02), and (3) electrolyte/acid-base disorders during CH and CL (<em>P</em> < 0.01). Sensitivity analysis (E-values) could not exclude unmeasured confounding from the model findings.</div></div><div><h3>Conclusions</h3><div>The COVID-19 pandemic led to substantial cost increases associated with nonelective major LEAs, but simple mediation analysis did not identify sensitive mediators to cost. This suggests systemic factors, such as supply chain disruptions and staffing shortages, may warrant investigation. The pandemic highlighted the need for resilient health-care systems that can address both acute and chronic care needs while mitigating inequities exacerbated by crises.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 315-322"},"PeriodicalIF":1.8000,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022480425002185","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

The COVID-19 pandemic significantly impacted health-care delivery and hospital financials. This study aims to identify the pandemic's effects on costs associated with nonelective major lower extremity amputation (LEA) and mediating factors influencing this cost.

Methods

The 2019-2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent nonelective LEA. Patient inflation-adjusted costs were collected. Florida COVID-19 mortality rates established 9-month COVID-heavy (CH) and COVID-light (CL) timeframes, compared to a 9-month pre-COVID (PC; 2019) timeframe. Simple mediation analysis with 2000 bootstrapping interactions evaluated patient comorbidity, surgical complications, and hospital treatment factors as potential mediators on cost.

Results

A total of 5963 patients were included (1957 PC, 1994 CH, 2012 CL). Compared to PC, COVID timeframes had significantly increased total (+7.8%), hospital (+14.5%), intensive care unit (+14.3%), and operating room (+14.9%) costs. Simple mediation analysis identified potential influencers of increased cost: (1) acute kidney injury during CL (P = 0.03), (2) sepsis during CL (P = 0.02), and (3) electrolyte/acid-base disorders during CH and CL (P < 0.01). Sensitivity analysis (E-values) could not exclude unmeasured confounding from the model findings.

Conclusions

The COVID-19 pandemic led to substantial cost increases associated with nonelective major LEAs, but simple mediation analysis did not identify sensitive mediators to cost. This suggests systemic factors, such as supply chain disruptions and staffing shortages, may warrant investigation. The pandemic highlighted the need for resilient health-care systems that can address both acute and chronic care needs while mitigating inequities exacerbated by crises.

查看原文本刊更多论文

因果非相关：截肢成本的简单中介分析

2019冠状病毒病大流行严重影响了卫生保健服务和医院财务状况。本研究旨在确定大流行对非选择性主要下肢截肢（LEA）相关费用的影响以及影响该费用的中介因素。方法查询2019-2021年佛罗里达州卫生保健管理局数据库中接受非选择性LEA的成年患者。收集经通货膨胀调整后的患者费用。与COVID-19前9个月（PC）相比，佛罗里达州COVID-19死亡率建立了9个月的COVID-19重（CH）和COVID-19轻（CL）时间框架；2019年)时间。使用2000个自举交互作用的简单中介分析评估了患者合并症、手术并发症和医院治疗因素作为成本的潜在中介因素。结果共纳入5963例患者（1957例PC， 1994例CH， 2012例CL）。与PC相比，COVID时间框架的总成本（+7.8%）、医院成本（+14.5%）、重症监护病房成本（+14.3%）和手术室成本（+14.9%）显著增加。简单的中介分析确定了成本增加的潜在影响因素：(1)CL期间的急性肾损伤（P = 0.03）， (2) CL期间的脓毒症（P = 0.02）， (3) CH和CL期间的电解质/酸碱紊乱(P <；0.01)。敏感性分析（e值）不能从模型结果中排除未测量的混杂因素。结论2019冠状病毒病大流行导致非选择性主要LEAs相关的成本大幅增加，但简单的中介分析未确定对成本敏感的中介。这表明，系统性因素，如供应链中断和人员短缺，可能需要调查。这次大流行突出表明，需要有复原力的卫生保健系统，既能满足急性病和慢性病的护理需求，又能减轻因危机而加剧的不公平现象。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.