接受择期微创结肠切除术的患者当天出院的全国趋势和费用。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-10-16 DOI:10.1016/j.amjsurg.2024.116021

Wardah Rafaqat , Mahin Janjua , Omar Mahmud , Bradford James , Baryalay Khan , Hanjo Lee , Aimal Khan

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引用次数: 0

摘要

背景：强化康复路径（ERP）使部分择期微创结肠切除术后的患者能够在当天安全出院（SDD）。我们旨在分析 SDD 对这些病例的财务影响：我们查询了全国再入院数据库（2016-2019 年），纳入了微创择期结肠切除术后住院时间≤2 天的患者。对手术当天出院的患者和术后第 1 天或第 2 天出院的患者进行倾向评分配对比较。我们的主要结果是住院和再入院的综合费用：SDD患者的合并症（33% 对 21%）和疾病严重程度（79% 对 63%）较低，医疗保险（44% 对 38%）较多，良性肿瘤（52% 对 17%）较多。大多数 SDD 患者接受了右结肠切除术（89%）。在 647 对配对患者中，SDD 患者的总费用明显较低（8000 美元对 12900 美元；P 结论：SDD 降低了患者的住院费用：SDD 降低了指数住院的费用，对特定的健康患者群体而言可能具有成本效益。

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National trends and costs of same day discharge in patients undergoing elective minimally invasive colectomy

Background

Enhanced Recovery Pathways (ERPs) have enabled safe same day discharge (SDD) of select patients after elective minimally invasive colectomy. We aimed to analyse the financial impact of SDD in these cases.

Methods

We queried the Nationwide Readmission Database (2016–2019) and included patients with a hospital length of stay ≤2 days after minimally invasive elective colectomy. Propensity score matched pairs of patients discharged on the day of the operation and those discharged on post operative day 1 or 2 were compared. Our primary outcome was the combined cost of hospitalization and readmission.

Results

SDD patients had lower comorbidity (33 % vs 21 %) and illness severity (79 % vs 63 %), more Medicare insurance (44 % vs 38 %), and more benign neoplasms (52 % vs 17 %). Most SDD patients underwent right colectomy (89 %). Across 647 matched pairs, total cost was significantly lower in SDD patients ($8000 vs. $12,900; p < 0.001) due to cheaper index hospitalizations. No difference in readmission rates or costs emerged.

Conclusion

SDD reduced costs of index hospitalization and may be cost-effective in a select cohort of healthier patients.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.