Statewide Variation in Practices and Charges for Primary Spontaneous Pneumothorax in Maryland, United States: A Retrospective Study
Background: The optimal treatment for primary spontaneous pneumothorax (PSP) remains undefined. Furthermore, the overall utilization and costs of various treatment approaches are incompletely understood. We investigated hospital charges and resource utilization by management strategy across the s...
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| Format: | Article |
| Language: | English |
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Korean Society for Thoracic & Cardiovascular Surgery
2025-01-01
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| Series: | Journal of Chest Surgery |
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| _version_ | 1841560942765146112 |
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| author | Grace Lassiter Eric Etchill Tamir Sholklapper Charbel Chidiac Joseph Canner Daniel Sangkyu Rhee |
| author_facet | Grace Lassiter Eric Etchill Tamir Sholklapper Charbel Chidiac Joseph Canner Daniel Sangkyu Rhee |
| author_sort | Grace Lassiter |
| collection | DOAJ |
| description | Background: The optimal treatment for primary spontaneous pneumothorax (PSP) remains
undefined. Furthermore, the overall utilization and costs of various treatment approaches
are incompletely understood. We investigated hospital charges and resource
utilization by management strategy across the state of Maryland in adult and pediatric
patients with PSP.
Methods: We queried the Maryland Health Services Cost Review Commission database
for patients aged 10–40 years admitted with PSP between 2012 and 2020. Patients managed
with a chest tube alone (CT) were compared with recipients of video-assisted thoracoscopic
surgery (VATS). Subsequently, we analyzed hospital charges for patients undergoing
early VATS (<48 hours post-admission) vs. delayed VATS (≥48 hours). The predicted
incremental cost of early vs. delayed VATS was calculated.
Results: Overall, 354 admissions were identified, with 211 (59.6%) receiving CT management
and 143 (40.4%) undergoing VATS. Patients receiving VATS were more likely to
be female (24% vs. 15%, p=0.030) and Black (32% vs. 20%, p=0.035) than CT recipients.
The median total hospital charge for CT recipients was $6,493, compared to $20,437 for
patients managed surgically (p<0.001). Delayed surgery during the index admission was
associated with significantly higher total hospital charges—including operating room,
room and board, radiology, and laboratory costs—than early surgery. Applying early VATS
to all patients appeared more cost-efficient than delayed VATS (per-patient costs: $18,568
vs. $30,832, p<0.001), although the former had slightly higher recurrence (7.9% vs. 1.5%,
p=0.08).
Conclusion: Variations in management strategies, particularly surgical decision-making
and timing, impact hospital charges and utilization for patients with PSP. |
| format | Article |
| id | doaj-art-1de64397f6b042b099c79f50fd6a3b21 |
| institution | Kabale University |
| issn | 2765-1606 2765-1614 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Korean Society for Thoracic & Cardiovascular Surgery |
| record_format | Article |
| series | Journal of Chest Surgery |
| spelling | doaj-art-1de64397f6b042b099c79f50fd6a3b212025-01-03T07:18:32ZengKorean Society for Thoracic & Cardiovascular SurgeryJournal of Chest Surgery2765-16062765-16142025-01-01581344310.5090/jcs.24.051Statewide Variation in Practices and Charges for Primary Spontaneous Pneumothorax in Maryland, United States: A Retrospective StudyGrace Lassiter0https://orcid.org/0000-0003-4487-786XEric Etchill1https://orcid.org/0000-0002-5381-648XTamir Sholklapper2https://orcid.org/0000-0002-2059-1966Charbel Chidiac3https://orcid.org/0000-0003-2294-8479Joseph Canner4Daniel Sangkyu Rhee5https://orcid.org/0000-0003-1895-6679Department of Anesthesia, Weil Cornell Medicine, New York, NYDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MDDepartment of Urology, Albert Einstein Healthcare Network, Philadelphia, PADepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MDDepartment of Surgery, Yale School of Medicine, New Haven, CTDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MDBackground: The optimal treatment for primary spontaneous pneumothorax (PSP) remains undefined. Furthermore, the overall utilization and costs of various treatment approaches are incompletely understood. We investigated hospital charges and resource utilization by management strategy across the state of Maryland in adult and pediatric patients with PSP. Methods: We queried the Maryland Health Services Cost Review Commission database for patients aged 10–40 years admitted with PSP between 2012 and 2020. Patients managed with a chest tube alone (CT) were compared with recipients of video-assisted thoracoscopic surgery (VATS). Subsequently, we analyzed hospital charges for patients undergoing early VATS (<48 hours post-admission) vs. delayed VATS (≥48 hours). The predicted incremental cost of early vs. delayed VATS was calculated. Results: Overall, 354 admissions were identified, with 211 (59.6%) receiving CT management and 143 (40.4%) undergoing VATS. Patients receiving VATS were more likely to be female (24% vs. 15%, p=0.030) and Black (32% vs. 20%, p=0.035) than CT recipients. The median total hospital charge for CT recipients was $6,493, compared to $20,437 for patients managed surgically (p<0.001). Delayed surgery during the index admission was associated with significantly higher total hospital charges—including operating room, room and board, radiology, and laboratory costs—than early surgery. Applying early VATS to all patients appeared more cost-efficient than delayed VATS (per-patient costs: $18,568 vs. $30,832, p<0.001), although the former had slightly higher recurrence (7.9% vs. 1.5%, p=0.08). Conclusion: Variations in management strategies, particularly surgical decision-making and timing, impact hospital charges and utilization for patients with PSP.primary spontaneous pneumothoraxvideo-assisted thoracoscopic surgerychest tubeshospital charges |
| spellingShingle | Grace Lassiter Eric Etchill Tamir Sholklapper Charbel Chidiac Joseph Canner Daniel Sangkyu Rhee Statewide Variation in Practices and Charges for Primary Spontaneous Pneumothorax in Maryland, United States: A Retrospective Study Journal of Chest Surgery primary spontaneous pneumothorax video-assisted thoracoscopic surgery chest tubes hospital charges |
| title | Statewide Variation in Practices and Charges for Primary Spontaneous Pneumothorax in Maryland, United States: A Retrospective Study |
| title_full | Statewide Variation in Practices and Charges for Primary Spontaneous Pneumothorax in Maryland, United States: A Retrospective Study |
| title_fullStr | Statewide Variation in Practices and Charges for Primary Spontaneous Pneumothorax in Maryland, United States: A Retrospective Study |
| title_full_unstemmed | Statewide Variation in Practices and Charges for Primary Spontaneous Pneumothorax in Maryland, United States: A Retrospective Study |
| title_short | Statewide Variation in Practices and Charges for Primary Spontaneous Pneumothorax in Maryland, United States: A Retrospective Study |
| title_sort | statewide variation in practices and charges for primary spontaneous pneumothorax in maryland united states a retrospective study |
| topic | primary spontaneous pneumothorax video-assisted thoracoscopic surgery chest tubes hospital charges |
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