Effect of patient factors on hospital costs for major bowel surgery: implications for managed health care.
BACKGROUND
We examined the effects of patient factors on hospital resource consumption for patients who had undergone major bowel operation (diagnosis-related groups [DRGs] 148 and 149) at an urban, university hospital.


METHODS
We performed cross-sectional analysis of computerized hospital discharge abstracts and charts of 491 consecutive discharges in these DRGs. Total hospital charges and length of stay were dependent variables. Independent variables included admission status, admission service, previous admissions, payer type, service type, diagnosis, reoperation, and death.


RESULTS
Patient factors accounted for significant variability in resource consumption. By univariate analysis all of the above variables significantly affected total charges, and all but service type significantly affected length of stay. By multivariate analysis DRGs 148/149 alone explained 4.2% of the variance, whereas all the variables together increased R2 to 52.1%. Logistic regression of reoperation and of death as dependent variables suggested that patient factors also accounted for significant variance in these outcomes.


CONCLUSIONS
Because patient factors may not be directly controllable by hospitals or physicians, differences among hospitals in costs and in "quality" may relate more to differences in patient mix than to efficiency. DRGs alone are not a sufficient management tool, and additional measures are needed to adequately measure both efficiency and quality.
Rhodes
R S
RS
Department of Surgery, University of Mississippi Medical Center, Jackson 39216-4505, USA.
Sharkey
P D
PD
Horn
S D
SD
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D004469:Economics, Hospital; D005260:Female; D006785:Hospitals, University / Q000191:economics; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007410:Intestinal Diseases / Q000191:economics* / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D012086:Reoperation; D014481:United States