Rance J T Fujiwara, Donald Tan, Hitomi Sakano, Brandon Isaacson, Joe Walter Kutz
{"title":"从1998年到2021年前庭神经鞘瘤切除术后住院费用和并发症发生率的增加。","authors":"Rance J T Fujiwara, Donald Tan, Hitomi Sakano, Brandon Isaacson, Joe Walter Kutz","doi":"10.1097/MAO.0000000000004498","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To examine temporal trends in postoperative surgical and medical complications after vestibular schwannoma (VS) resections, and to describe changes in inpatient hospitalization costs.</p><p><strong>Study design: </strong>Cross-sectional analysis.</p><p><strong>Setting: </strong>National Inpatient Sample, 1998-2021.</p><p><strong>Participants: </strong>50,991 admissions.</p><p><strong>Interventions: </strong>VS resection.</p><p><strong>Main outcome measures: </strong>Surgical and medical complications after VS resection were recorded annually and trended over time. The annual average cost of inpatient hospitalization (in inflation adjusted 2024 US dollars) and length of stay were also documented for each year. Multivariate analysis was performed to determine whether subsequent calendar years were associated with changes in costs.</p><p><strong>Results: </strong>From 1998 to 2021, the annual average number of VS resections decreased by 32.7% from 3,813 to 2,557. Rates of surgical and medical complications increased from 18.2 to 34.2% (b = 0.73 [95% CI, 0.53-0.93], p < 0.001), and from 4.3 to 7.6% (b = 0.17 [95% CI, 0.11-0.22], p < 0.001), respectively. The number of comorbidities among surgical patients increased over time, and rates of complications increased among patients with higher comorbidity scores, with 54.0% of those with ≥4 comorbidities experience a complication, compared with 28.1% of those with no comorbidities. The mean inpatient cost per admission increased from $30,922 to $45,973, which was statistically significant on multivariate regression (b = $412 [95% CI, 208-615], p < 0.001), despite a decrease in average inpatient stay from 5.4 (SE 0.5) to 4.5 (SE 0.3) days.</p><p><strong>Conclusions: </strong>As the number of VS operations has decreased, the percentage with postoperative complications has increased, likely due to changes in patient selection as well as increasing comorbidities in operative cases. Healthcare expenditures for postoperative admissions have increased significantly over the last two decades, resulting in a roughly $15,000 increase in mean inflation-adjusted inpatient costs per postoperative admission.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Increasing Inpatient Costs and Complication Rates After Vestibular Schwannoma Resections from 1998 to 2021.\",\"authors\":\"Rance J T Fujiwara, Donald Tan, Hitomi Sakano, Brandon Isaacson, Joe Walter Kutz\",\"doi\":\"10.1097/MAO.0000000000004498\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To examine temporal trends in postoperative surgical and medical complications after vestibular schwannoma (VS) resections, and to describe changes in inpatient hospitalization costs.</p><p><strong>Study design: </strong>Cross-sectional analysis.</p><p><strong>Setting: </strong>National Inpatient Sample, 1998-2021.</p><p><strong>Participants: </strong>50,991 admissions.</p><p><strong>Interventions: </strong>VS resection.</p><p><strong>Main outcome measures: </strong>Surgical and medical complications after VS resection were recorded annually and trended over time. The annual average cost of inpatient hospitalization (in inflation adjusted 2024 US dollars) and length of stay were also documented for each year. Multivariate analysis was performed to determine whether subsequent calendar years were associated with changes in costs.</p><p><strong>Results: </strong>From 1998 to 2021, the annual average number of VS resections decreased by 32.7% from 3,813 to 2,557. Rates of surgical and medical complications increased from 18.2 to 34.2% (b = 0.73 [95% CI, 0.53-0.93], p < 0.001), and from 4.3 to 7.6% (b = 0.17 [95% CI, 0.11-0.22], p < 0.001), respectively. The number of comorbidities among surgical patients increased over time, and rates of complications increased among patients with higher comorbidity scores, with 54.0% of those with ≥4 comorbidities experience a complication, compared with 28.1% of those with no comorbidities. The mean inpatient cost per admission increased from $30,922 to $45,973, which was statistically significant on multivariate regression (b = $412 [95% CI, 208-615], p < 0.001), despite a decrease in average inpatient stay from 5.4 (SE 0.5) to 4.5 (SE 0.3) days.</p><p><strong>Conclusions: </strong>As the number of VS operations has decreased, the percentage with postoperative complications has increased, likely due to changes in patient selection as well as increasing comorbidities in operative cases. Healthcare expenditures for postoperative admissions have increased significantly over the last two decades, resulting in a roughly $15,000 increase in mean inflation-adjusted inpatient costs per postoperative admission.</p>\",\"PeriodicalId\":19732,\"journal\":{\"name\":\"Otology & Neurotology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Otology & Neurotology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MAO.0000000000004498\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Otology & Neurotology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MAO.0000000000004498","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:探讨前庭神经鞘瘤(VS)切除术后手术和医疗并发症的时间趋势,并描述住院患者住院费用的变化。研究设计:横断面分析。背景:1998-2021年全国住院患者样本。参与者:50,991人。干预措施:VS切除术。主要结局指标:每年记录VS切除术后的外科和内科并发症并随时间变化。还记录了每年的平均住院费用(按通货膨胀调整后的2024美元计算)和住院时间。进行多变量分析以确定随后历年是否与成本变化有关。结果:从1998年到2021年,年平均VS切除数量从3813例下降到2557例,下降了32.7%。手术和内科并发症的发生率分别从18.2%增加到34.2% (b = 0.73 [95% CI, 0.53-0.93], p < 0.001)和从4.3%增加到7.6% (b = 0.17 [95% CI, 0.11-0.22], p < 0.001)。手术患者中合并症的数量随着时间的推移而增加,合并症评分较高的患者并发症发生率增加,合并症≥4的患者中有54.0%出现并发症,而无合并症的患者中有28.1%出现并发症。尽管平均住院时间从5.4天(SE 0.5)减少到4.5天(SE 0.3),但每次入院的平均住院费用从30,922美元增加到45,973美元,这在多变量回归上具有统计学意义(b = 412美元[95% CI, 208-615], p < 0.001)。结论:随着VS手术次数的减少,术后并发症的比例增加,这可能是由于患者选择的改变以及手术病例合并症的增加。在过去二十年中,术后住院的医疗保健支出显著增加,导致每次术后住院的平均通货膨胀调整后的住院费用增加了大约15,000美元。
Increasing Inpatient Costs and Complication Rates After Vestibular Schwannoma Resections from 1998 to 2021.
Objective: To examine temporal trends in postoperative surgical and medical complications after vestibular schwannoma (VS) resections, and to describe changes in inpatient hospitalization costs.
Study design: Cross-sectional analysis.
Setting: National Inpatient Sample, 1998-2021.
Participants: 50,991 admissions.
Interventions: VS resection.
Main outcome measures: Surgical and medical complications after VS resection were recorded annually and trended over time. The annual average cost of inpatient hospitalization (in inflation adjusted 2024 US dollars) and length of stay were also documented for each year. Multivariate analysis was performed to determine whether subsequent calendar years were associated with changes in costs.
Results: From 1998 to 2021, the annual average number of VS resections decreased by 32.7% from 3,813 to 2,557. Rates of surgical and medical complications increased from 18.2 to 34.2% (b = 0.73 [95% CI, 0.53-0.93], p < 0.001), and from 4.3 to 7.6% (b = 0.17 [95% CI, 0.11-0.22], p < 0.001), respectively. The number of comorbidities among surgical patients increased over time, and rates of complications increased among patients with higher comorbidity scores, with 54.0% of those with ≥4 comorbidities experience a complication, compared with 28.1% of those with no comorbidities. The mean inpatient cost per admission increased from $30,922 to $45,973, which was statistically significant on multivariate regression (b = $412 [95% CI, 208-615], p < 0.001), despite a decrease in average inpatient stay from 5.4 (SE 0.5) to 4.5 (SE 0.3) days.
Conclusions: As the number of VS operations has decreased, the percentage with postoperative complications has increased, likely due to changes in patient selection as well as increasing comorbidities in operative cases. Healthcare expenditures for postoperative admissions have increased significantly over the last two decades, resulting in a roughly $15,000 increase in mean inflation-adjusted inpatient costs per postoperative admission.
期刊介绍:
Otology & Neurotology publishes original articles relating to both clinical and basic science aspects of otology, neurotology, and cranial base surgery. As the foremost journal in its field, it has become the favored place for publishing the best of new science relating to the human ear and its diseases. The broadly international character of its contributing authors, editorial board, and readership provides the Journal its decidedly global perspective.