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 res ource 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 computeri zed hospital discharge abstracts and charts of 491 consecutive dischar ges in these DRGs. Total hospital charges and length of stay were depe ndent variables. Independent variables included admission status, admi ssion service, previous admissions, payer type, service type, diagnosi s, reoperation, and death. Results. Patient factors accounted for sign ificant variability in resource consumption. By univariate analysis al l of the above variables significantly affected total charges, and all but service type significantly affected length of stay. By multivaria te analysis DRGs 148/149 alone explained 4.2% of the variance, whereas all the variables together increased R(2) to 52.1%. Logistic regressi on of reoperation and of death as dependent variables suggested that p atient factors also accounted for significant variance in these outcom es. Conclusions. Because patient factors may not be directly controlla ble by hospitals or physicians, differences among hospitals in costs a nd in ''quality'' may relate more to differences in patient mix than t o efficiency. DRGs alone are not a sufficient management tool, and add itional measures are needed to adequately measure both efficiency and quality.