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Multicenter Study Journal of the American College of Surgeons. 2018 Jun;226(6):1014-1021. doi: 10.1016/j.jamcollsurg.2017.11.004 Q13.82024

Influence of Time to Appendectomy and Operative Duration on Hospital Cost in Children with Uncomplicated Appendicitis

儿童急性单纯性阑尾炎的手术时机及手术时间对住院费用的影响 翻译改进

Stephanie K Serres  1, Dionne A Graham  2, Charity C Glass  1, Danielle B Cameron  1, Seema P Anandalwar  1, Shawn J Rangel  3

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作者单位

  • 1 Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
  • 2 Center for Applied Quality Analytics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
  • 3 Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: shawn.rangel@childrens.harvard.edu.

    • DOI: 10.1016/j.jamcollsurg.2017.11.004 PMID: 29155269

    摘要 Ai翻译

    Background: The goal of this study was to examine the influence of time to appendectomy (TTA) and operative duration (OD) on hospital cost as surrogate measures of perioperative efficiency.

    Study design: We conducted a retrospective cohort analysis of 2,116 children undergoing appendectomy for uncomplicated appendicitis at 16 children's hospitals from January 2013 to December 2014. Time to appendectomy (emergency department presentation to incision) and OD were obtained from the NSQIP Pediatric Appendectomy Pilot Database and merged with cost data from the Pediatric Health Information System Database. Multivariate regression was used to examine the influence of TTA and OD (categorized by quartiles of hospital-level means) on hospital cost, adjusting for patient and hospital-level characteristics.

    Results: Median TTA and OD across all patients was 7.3 hours (interquartile range 4.4 to 12.4 hours) and 36 minutes (interquartile range 26 to 49 minutes), respectively. The longest quartile of OD was associated with 38% higher total cost ($2,512/case; rate ratio [RR] 1.38; 95% CI 1.27 to 1.5; p < 0.001) and 27% higher operating room-associated cost ($960/case; RR 1.27; 95% CI 1.22 to 1.34; p < 0.001) compared with the shortest quartile. The longest quartile of TTA was associated with 23% higher total cost ($1,589/case; RR 1.23; 95% CI 1.14 to 1.32; p < 0.001) and 53% higher room-associated cost ($906/case; RR 1.53; 95% CI 1.35 to 1.74; p < 0.001) compared with the shortest quartile. The influence of TTA and OD were independent but potentiating effects, with median cost for hospitals in both the longest quartiles of TTA and OD being 79% higher than those in the shortest quartiles.

    Conclusions: Longer TTA and OD were independently associated with increased hospital cost, with OD being the most significant driver of cost variation across hospitals. Identification of best practices from high-efficiency hospitals might provide a high-yield strategy for improving value in appendicitis care.

    Keywords：time to appendectomy; operative duration; hospital cost

    关键词：阑尾切除时间; 手术持续时间; 住院费用

    Copyright © Journal of the American College of Surgeons. 中文内容为AI机器翻译，仅供参考！

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    期刊名：Journal of the american college of surgeons

    缩写：J AM COLL SURGEONS

    ISSN：1072-7515

    e-ISSN：1879-1190

    IF/分区：3.8/Q1

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    Influence of Time to Appendectomy and Operative Duration on Hospital Cost in Children with Uncomplicated Appendicitis