Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care
Abstract
:1. Introduction
2. Method
2.1. Data Collection
2.2. Statistical Analysis
3. Results
3.1. Descriptive Statistics
Quality Indicators
3.2. Moderated Multiple Linear Model
3.2.1. Model Assessment
3.2.2. Surgery Type
3.2.3. Surgery Time
3.2.4. Impact of Surgery Time Depending on the Age of the Patients
3.2.5. Outpatient Clinic Care Time
4. Discussion
5. Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
PROMS | Patient Reported Outcome Measure |
EHS | European Hernia Society |
IEHS | International Endohernia Society |
GZO | Gesundheitszentrum Zürich Oberland |
CHF | Swiss Franc |
SwissDRG | Swiss Diagnosis Related Groups |
ASA | American Society of Anesthesiologists |
DRG | Diagnosis Related Groups |
TARMED | (Swiss Federal Health Insurance Act) |
PWC | PricewaterhouseCoopers |
BFS | Bundesamt für Statistik (Federal office for statistics) |
GDP | Gross Domestic Product |
EUR | Euro |
WHO | World Health Organization |
OR | Operating Room |
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Variables | N | M | SD | Min | Q1 | Md | Q3 | Max |
---|---|---|---|---|---|---|---|---|
All patients | ||||||||
Age | 234 | 59.44 | 17.12 | 19 | 47 | 62 | 73 | 88 |
Anesthesia time | 234 | 122.92 | 39.05 | 0 | 96 | 123 | 149 | 235 |
Surgery time | 234 | 60.82 | 28.44 | 0 | 39 | 56 | 76 | 160 |
Stationary care time | 234 | 165.30 | 223.66 | 0 | 0 | 0 | 361 | 929 |
Outpatient clinic care time | 234 | 44.80 | 39.05 | 0 | 15 | 40 | 60 | 300 |
Recovery room care time | 234 | 60.75 | 46.74 | 0 | 0 | 67 | 93 | 230 |
Doctors costs | 234 | 855.87 | 822.12 | 72.47 | 320.65 | 521.05 | 1132.81 | 6280.61 |
Material costs | 234 | 672.11 | 271.42 | 246.63 | 527.13 | 696.54 | 778.78 | 3089.02 |
Final Revenue | 234 | −95.36 | 1624.42 | −4807.04 | −851.07 | 33.21 | 586.36 | 16,207.03 |
Stationary treated patients | ||||||||
Age | 88 | 65.41 | 16.38 | 20 | 53 | 71 | 77 | 88 |
Anesthesia time | 88 | 146.64 | 34.08 | 61 | 122 | 143 | 169 | 235 |
Surgery time | 88 | 76.05 | 31.38 | 30 | 50 | 73 | 97 | 160 |
Stationary care time | 88 | 424.78 | 148.08 | 178 | 338 | 385 | 474 | 929 |
Outpatient clinic care time | 40 | 47.25 | 34.40 | 15 | 15 | 45 | 68 | 150 |
Recovery room care time | 76 | 98.97 | 36.26 | 36 | 72 | 96 | 119 | 230 |
Doctors costs | 88 | 686.32 | 372.17 | 246.63 | 398.60 | 686.45 | 843.28 | 3089.02 |
Material costs | 88 | 1595.77 | 926.86 | 456.66 | 1011.27 | 1407.37 | 1822.99 | 6280.61 |
Final Revenue | 88 | −575.01 | 2405.49 | −4807.04 | −1819.18 | −869.06 | 159.22 | 16,207.03 |
Partially stationary treated patients | ||||||||
Age | 107 | 55.55 | 16.01 | 20 | 43 | 59 | 66 | 88 |
Anesthesia time | 106 | 124.43 | 25.70 | 65 | 105 | 124 | 142 | 198 |
Surgery time | 106 | 57.80 | 21.77 | 21 | 41 | 56 | 72 | 120 |
Stationary care time | 7 | 185.71 | 60.02 | 108 | 145 | 163 | 242 | 256 |
Outpatient clinic care time | 102 | 61.40 | 35.92 | 10 | 40 | 48 | 91 | 300 |
Recovery room care time | 98 | 68.31 | 27.31 | 1 | 51 | 68 | 85 | 190 |
Doctors costs | 107 | 654.96 | 201.98 | 250.91 | 572.63 | 687.46 | 735.71 | 1398.09 |
Material costs | 107 | 409.14 | 170.52 | 89.71 | 300.14 | 377.08 | 476.48 | 1102.31 |
Final Revenue | 107 | −24.73 | 690.76 | −2042.53 | −389.02 | 77.84 | 383.37 | 1804.31 |
Outpatient clinic patients | ||||||||
Age | 39 | 56.62 | 18.29 | 19 | 43 | 62 | 72 | 79 |
Anesthesia time | 39 | 68.44 | 10.57 | 48 | 60 | 70 | 75 | 88 |
Surgery time | 39 | 36.23 | 10.72 | 19 | 28 | 37 | 43 | 68 |
Stationary care time | 0 | 0.00 | 0.00 | 0 | 0 | 0 | 0 | 0 |
Outpatient clinic care time | 39 | 59.77 | 30.50 | 25 | 40 | 60 | 60 | 135 |
Recovery room care time | 0 | 0.00 | 0.00 | 0 | 0 | 0 | 0 | 0 |
Doctors costs | 39 | 687.07 | 138.81 | 258.94 | 614.40 | 725.11 | 785.64 | 888.48 |
Material costs | 39 | 411.99 | 253.72 | 72.47 | 248.06 | 292.41 | 516.24 | 1034.99 |
Final Revenue | 39 | 793.12 | 493.90 | −502.19 | 537.12 | 974.05 | 1161.35 | 1499.28 |
Variable | Categories | Stationary | Partially Stationary | Outpatient Center |
---|---|---|---|---|
Surgery type | Open surgery | 37.5% | 15.9% | 2.6% |
Laparoscopic | 62.5% | 84.1% | 97.4% | |
Incarcerated hernia | No | 81.8% | 100.0% | 100.0% |
Yes | 18.2% | 0.0% | 0.0% | |
Care in department | No | 0.0% | 93.5% | 100.0% |
Yes | 100.0% | 6.5% | 0.0% | |
Care in outpatient clinic | No | 54.5% | 4.7% | 0.0% |
Yes | 45.5% | 95.3% | 100.0% | |
Care in recovery room | No | 13.6% | 8.4% | 100.0% |
Yes | 86.4% | 91.6% | 0.0% | |
Insurance type | General | 85.2% | 92.5% | 76.9% |
Private | 14.8% | 7.5% | 23.1% |
Estimate | SE | t Value | p Value | Weight | Tolerances | |
---|---|---|---|---|---|---|
Age | −1.407 | 4.194 | −0.335 | 0.738 | −0.015 | 0.881 |
Doctors costs | 0.960 | 0.156 | 6.162 | 0.000 | 0.486 | 0.493 |
Material costs | −0.359 | 0.303 | −1.183 | 0.238 | −0.060 | 0.768 |
Surgery time | −17.611 | 5.582 | −3.155 | 0.002 | −0.308 | 0.398 |
Anesthesia time | −10.443 | 4.705 | −2.220 | 0.027 | −0.251 | 0.344 |
Stationary care time | −0.706 | 0.697 | −1.014 | 0.312 | −0.097 | 0.406 |
Outpatient clinic care time | −6.083 | 1.882 | −3.233 | 0.001 | −0.146 | 0.861 |
Recovery room care time | 4.210 | 1.790 | 2.352 | 0.020 | 0.121 | 0.756 |
Stay type (partially stationary) | 1094.985 | 341.883 | 3.203 | 0.002 | 0.674 | 0.508 |
Stay type (outpatient clinic) | 1200.142 | 435.829 | 2.754 | 0.006 | 0.739 | 0.508 |
Surgery type (laparoscopic) | 329.625 | 226.627 | 1.454 | 0.147 | 0.203 | 0.674 |
Incarcerated hernia (yes) | −418.333 | 274.324 | −1.525 | 0.129 | −0.258 | 0.911 |
Insurance type (private) | −20.959 | 230.975 | −0.091 | 0.928 | −0.013 | 0.817 |
Variable | Estimate | SE | t Value | p Value | Weight |
---|---|---|---|---|---|
(Intercept) | −2255.01 | 386.26 | −5.84 | 0.000 | −1.33 |
Doctors costs | 2.62 | 0.42 | 6.25 | 0.000 | 1.32 |
Material costs | −0.23 | 0.63 | −0.36 | 0.718 | −0.04 |
Surgery time | −13.43 | 7.02 | −1.91 | 0.058 | −0.24 |
Anesthesia time | −17.40 | 4.92 | −3.54 | 0.001 | −0.42 |
Stationary care time | 2.35 | 0.81 | 2.90 | 0.004 | 0.32 |
Outpatient clinic care time | −19.23 | 3.23 | −5.95 | 0.000 | −0.46 |
Recovery room care time | 2.07 | 1.02 | 2.02 | 0.045 | 0.06 |
Age | 24.73 | 6.40 | 3.87 | 0.000 | 0.26 |
Incarcerated hernia (yes) | 3930.21 | 1752.31 | 2.24 | 0.027 | 2.42 |
Insurance (private) | −10,729.66 | 1182.83 | −9.07 | 0.000 | −6.61 |
Stay type (partially stationary) | 2174.90 | 557.31 | 3.90 | 0.000 | 1.34 |
Stay type (outpatient clinic) | 4654.06 | 2074.74 | 2.24 | 0.027 | 2.87 |
Surgery type (laparoscopic) | 1516.01 | 421.52 | 3.60 | 0.000 | 0.93 |
Surgery type (laparoscopic): Stay type (partially stationary) | −2052.88 | 610.18 | −3.36 | 0.001 | −1.26 |
Surgery type (laparoscopic): Stay type (outpatient clinic) | −2486.49 | 973.02 | −2.56 | 0.012 | −1.53 |
Surgery time: Stay type (partially stationary) | 26.35 | 14.99 | 1.76 | 0.081 | 0.46 |
Surgery time: Stay type (outpatient clinic) | 112.04 | 55.18 | 2.03 | 0.044 | 1.96 |
Surgery time: Age: Stay type (partially stationary) | 0.66 | 0.16 | 4.17 | 0.000 | 0.20 |
Surgery time: Age: Stay type (outpatient clinic) | 0.54 | 0.57 | 0.96 | 0.339 | 0.16 |
Outpatient clinic care time: Stay type (partially stationary) | 30.10 | 4.84 | 6.22 | 0.000 | 0.72 |
Outpatient clinic care time: Stay type (outpatient clinic) | 37.05 | 6.80 | 5.44 | 0.000 | 0.89 |
Doctors costs: Stay type (partially stationary) | −3.42 | 0.51 | −6.77 | 0.000 | −1.73 |
Doctors costs: Stay type (outpatient clinic) | −5.16 | 3.05 | −1.69 | 0.093 | −2.61 |
Doctors costs: Surgery time: Stay type (partially stationary) | 0.06 | 0.03 | 2.24 | 0.027 | 0.86 |
Doctors costs: Surgery time: Stay type (outpatient clinic) | 0.10 | 0.06 | 1.63 | 0.106 | 1.37 |
Doctors costs: Anesthesia time: Stay type (partially stationary) | −0.07 | 0.02 | −2.81 | 0.006 | −1.30 |
Doctors costs: Anesthesia time: Stay type (outpatient clinic) | −0.08 | 0.07 | −1.03 | 0.306 | −1.50 |
Doctors costs: Insurance (private): Stay type (partially stationary) | −3.58 | 1.53 | −2.35 | 0.020 | −1.81 |
Doctors costs: Insurance (private): Stay type (outpatient clinic) | −2.49 | 1.00 | −2.50 | 0.014 | −1.26 |
Material costs: Stay type (partially stationary) | 1.15 | 0.84 | 1.38 | 0.170 | 0.19 |
Material costs: Stay type (outpatient clinic) | −2.96 | 3.49 | −0.85 | 0.398 | −0.49 |
Material costs: Surgery time: Stay type (partially stationary) | 0.12 | 0.02 | 5.53 | 0.000 | 0.56 |
Material costs: Surgery time: Stay type (outpatient clinic) | 0.14 | 0.16 | 0.87 | 0.388 | 0.66 |
Material costs: Anesthesia time: Stay type (partially stationary) | −0.07 | 0.02 | −3.53 | 0.001 | −0.45 |
Material costs: Anesthesia time: Stay type (outpatient clinic) | −0.16 | 0.11 | −1.50 | 0.137 | −1.04 |
Material costs: Insurance (private): Stay type (partially stationary) | −27.85 | 5.09 | −5.48 | 0.000 | −4.65 |
Material costs: Insurance (private): Stay type (outpatient clinic) | −26.43 | 6.08 | −4.35 | 0.000 | −4.42 |
Age: Stay type (partially stationary) | −37.70 | 9.89 | −3.81 | 0.000 | −0.40 |
Age: Stay type (outpatient clinic) | −23.15 | 18.28 | −1.27 | 0.208 | −0.24 |
Insurance (private): Stay type (partially stationary) | 9395.59 | 1537.24 | 6.11 | 0.000 | 5.78 |
Insurance (private): Stay type (outpatient clinic) | 9205.35 | 1732.66 | 5.31 | 0.000 | 5.67 |
Insurance (private): Age: Stay type (partially stationary) | −308.22 | 73.39 | −4.20 | 0.000 | −3.25 |
Insurance (private): Age: Stay type (outpatient clinic) | −204.63 | 58.74 | −3.48 | 0.001 | −2.16 |
Stay Type | Variable | Estimate | SE | t Value | p Value | Weight |
---|---|---|---|---|---|---|
Stationary | Outpatient clinic care time | −19.76 | 3.58 | −5.51 | 0.000 | −0.48 |
Partially stationary | Outpatient clinic care time | 10.34 | 1.83 | 5.65 | 0.000 | 0.25 |
Outpatient clinic | Outpatient clinic care time | 17.29 | 4.13 | 4.19 | 0.000 | 0.42 |
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Enodien, B.; Moser, D.; Kessler, F.; Taha-Mehlitz, S.; Frey, D.M.; Taha, A. Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care. Int. J. Environ. Res. Public Health 2022, 19, 12410. https://doi.org/10.3390/ijerph191912410
Enodien B, Moser D, Kessler F, Taha-Mehlitz S, Frey DM, Taha A. Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care. International Journal of Environmental Research and Public Health. 2022; 19(19):12410. https://doi.org/10.3390/ijerph191912410
Chicago/Turabian StyleEnodien, Bassey, Dominik Moser, Florian Kessler, Stephanie Taha-Mehlitz, Daniel M. Frey, and Anas Taha. 2022. "Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care" International Journal of Environmental Research and Public Health 19, no. 19: 12410. https://doi.org/10.3390/ijerph191912410
APA StyleEnodien, B., Moser, D., Kessler, F., Taha-Mehlitz, S., Frey, D. M., & Taha, A. (2022). Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care. International Journal of Environmental Research and Public Health, 19(19), 12410. https://doi.org/10.3390/ijerph191912410