위암 환자에서 개복 수술과 복강경 수술 결과 및 재원일수와 입원비용에 차이를 발생시키는 동반질환 분석: 건강보험 청구데이터를 활용하여
Analysis of Outcomes in Open and Laparoscopic Surgeries for Gastric Cancer Patients and Impact of Comorbidity on Differences in Length of Stay and Hospital Costs: Using Healthcare Claims Database
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Objectives: The aim of this study was to analyze factors affecting the outcomes of gastrectomy in gastric cancer patients, and to identify comorbidities that influence the length of stay and hospital costs differences between open surgeries (OS) and laparoscopic surgeries (LS). Methods: We extracted all health insurance claim data for patients who underwent gastrectomy with gastric cancer as the primary diagnosis from 2019 to 2021, as provided by the Health Insurance Review and Assessment Service in Korea. Univariate analysis was performed to examine differences in general characteristics and dis- tribution of comorbidities between the OS and LS patient groups. Additionally, differences in mean length of stay and mean hospital costs were ana- lyzed. Furthermore, using multivariate analysis, we evaluated factors influencing surgical outcomes. To identify comorbidities contributing to differences in length of stay and hospital costs between the two surgical methods, we compared results from univariate and multivariate analyses for each comor- bidity. Results: The multivariate regression analysis of general characteristics revealed that LS had a shorter length of stay and higher hospital costs com- pared to OS. The analysis of comorbidities, both in univariate and multivariate analyses, consistently indicated that chronic pulmonary disease and peptic ulcer disease were the diseases that caused differences in length of stay and hospital costs between OS and LS. Conclusions: Efforts to consider surgical methods based on patient characteristics and comorbidities are essential to ensure the efficient allocation of medical resources.
Abstract
Objectives: The aim of this study was to analyze factors affecting the outcomes of gastrectomy in gastric cancer patients, and to identify comorbidities that influence the length of stay and hospital costs differences between open surgeries (OS) and laparoscopic surgeries (LS). Methods: We extracted all health insurance claim data for patients who underwent gastrectomy with gastric cancer as the primary diagnosis from 2019 to 2021, as provided by the Health Insurance Review and Assessment Service in Korea. Univariate analysis was performed to examine differences in general characteristics and dis- tribution of comorbidities between the OS and LS patient groups. Additionally, differences in mean length of stay and mean hospital costs were ana- lyzed. Furthermore, using multivariate analysis, we evaluated factors influencing surgical outcomes. To identify comorbidities contributing to differences in length of stay and hospital costs between the two surgical methods, we compared results from univariate and multivariate analyses for each comor- bidity. Results: The multivariate regression analysis of general characteristics revealed that LS had a shorter length of stay and higher hospital costs com- pared to OS. The analysis of comorbidities, both in univariate and multivariate analyses, consistently indicated that chronic pulmonary disease and peptic ulcer disease were the diseases that caused differences in length of stay and hospital costs between OS and LS. Conclusions: Efforts to consider surgical methods based on patient characteristics and comorbidities are essential to ensure the efficient allocation of medical resources.
참고문헌 (25)
- "Annual report of cancer statistics in Korea in 2017"[URL]
- "Annual report of cancer statistics in Korea in 2018"[URL]
- "Annual report of cancer statistics in Korea in 2019"[URL]
- "Annual report of cancer statistics in Korea in 2020"[URL]
- Jian-Xian Lin, "Surgical Outcomes of 2041 Consecutive Laparoscopic Gastrectomy Procedures for Gastric Cancer: A Large-Scale Case Control Study", PLOS ONE, 10(2), pp.e0114948~ (2015), Public Library of Science (PLoS)[DOI]
- Hyung-Ho Kim, "Effect of Laparoscopic Distal Gastrectomy vs Open Distal Gastrectomy on Long-term Survival Among Patients With Stage I Gastric Cancer", JAMA Oncology, 5(4), pp.506~ (2019), American Medical Association (AMA)[DOI]
- Sang-Yong Son, "Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer", JAMA Surgery, 157(10), pp.879~ (2022), American Medical Association (AMA)[DOI]
- Yu J, "Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer the CLASS-01 randomized clinical trial", JAMA, 321(20), pp.1983~1992 (2019)[DOI]
- Roger Mulder, "The limitations of using randomised controlled trials as a basis for developing treatment guidelines", Evidence Based Mental Health, 21(1), pp.4~6 (2017), BMJ[DOI]
- Yang JY, "Utilization of real-world evidence(RWE)in medical device regulatory decisions", Pharmacoepidemiol Risk Manag, 11, pp.121~134 (2019)
- 박일수, "보건의료연구를 위한 건강보험 자료의 효과적 활용방법", 보건정보통계학회지, pp.31~39 (2022), 한국보건정보통계학회
- Hyojung Hwang, "Laparoscopic surgery versus open surgery for gastric cancer: big data analysis based on nationwide administrative claims data", Annals of Surgical Treatment and Research, 99(3), pp.138~145 (2020), 대한외과학회
- Sahil Gambhir, "Short- and long-term survival after laparoscopic versus open total gastrectomy for gastric adenocarcinoma: a National database study", Surgical Endoscopy, 35(4), pp.1872~1878 (2020), Springer Science and Business Media LLC[DOI]
- J. Yu, "The impact of age and comorbidity on postoperative complications in patients with advanced gastric cancer after laparoscopic D2 gastrectomy: Results from the Chinese laparoscropic gastrointestinal surgery study (CLASS) group", European Journal of Surgical Oncology (EJSO), 39(10), pp.1144~1149 (2013), Elsevier BV[DOI]
- 김경훈, "건강보험청구자료에서 동반질환 보정방법", 보건행정학회지, 26(1), pp.71~78 (2016), 한국보건행정학회
- Hude Quan, "Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data", Medical Care, 43(11), pp.1130~1139 (2005), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Takashi Sakamoto, "Short-Term Outcomes of Laparoscopic and Open Total Gastrectomy for Gastric Cancer: A Nationwide Retrospective Cohort Analysis", Annals of Surgical Oncology, 27(2), pp.518~526 (2019), Springer Science and Business Media LLC[DOI]
- Yeh CC, "Diabetes mellitus and cerebrovascular disease as independent determinants for increased hospital costs and length of stay in open appendectomy in comparison with laparoscopic appendectomy : A nationwide cohort study", Am Surg, 78(3), pp.329~334 (2012)
- Health Insurance Review & Assessment Service, "Assessment results of colorectal liver cancer treatment outcomes in 2010", Health Insurance Review & Assessment Service, ~ (2012)
- 조수진, "선별급여 도입이 위암수술의 건강보험 진료비 및 진료행태에 미치는 영향", 보건행정학회지, 26(1), pp.63~70 (2016), 한국보건행정학회
- Wook Kim, "The Impact of Comorbidity on Surgical Outcomes in Laparoscopy-Assisted Distal Gastrectomy", Annals of Surgery, 248(5), pp.793~799 (2008), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Mikito Inokuchi, "Impact of comorbidities on postoperative complications in patients undergoing laparoscopy-assisted gastrectomy for gastric cancer", BMC Surgery, 14(1) (2014), Springer Science and Business Media LLC[DOI]
- 김종진, "만성 폐쇄성 폐질환을 동반한 위암 환자에서의 복강경 위 절제술", Journal of Minimally Invasive Surgery, 12(2), pp.78~83 (2009), 대한내시경로봇외과학회
- 박종혁, "유방암 수술 후 장기 생존의 예측인자로서 Charlson Comorbidity Index: 한국에서 전국적인 후향적 코호트 연구", Journal of Breast Cancer, 13(4), pp.409~417 (2010), 한국유방암학회
- 조금준, "의료 빅데이터를 활용한 임상 연구", Anesthesia and Pain Medicine, 12(1), pp.9~14 (2017), 대한마취통증의학회