Economic burden and determinants of hospitalization costs in patients undergoing parastomal hernia repair: a quantile regression analysis.

Abstract

<h4>Background</h4>Parastomal hernia (PSH) repair imposes substantial economic burdens, yet factors influencing hospitalization costs remain inadequately characterized. Quantile regression provides insights into cost determinants beyond traditional mean-based analyses. This study aimed to identify key predictors of hospitalization costs associated with PSH repair using quantile regression.<h4>Methods</h4>This retrospective study included patients undergoing PSH repair at Beijing Chao-Yang Hospital (2012-2024). Hospitalization cost data, demographic variables, clinical characteristics, and procedural details were collected. Quantile regression was utilized to examine cost determinants across hospitalization cost quantiles (10th-90th percentiles). Regression coefficients (β) are interpreted on the outcome scale, with β denoting the adjusted cost difference in Chinese Yuan (CNY) for indicator variables and the adjusted change in cost per one-unit increase for continuous variables (CNY per unit), and positive values indicate higher costs while negative values indicate lower costs. All costs are reported in Chinese Yuan (RMB; ¥1 ≈ 0.14 United States Dollar [USD] and ≈ 0.13 Euro [EUR], based on 2024 average exchange rate).<h4>Results</h4>A total of 1,113 patients were included, of whom 571 (51.3%) were male, and 740 (66.5%) were aged ≥ 65 years. Univariate analysis showed that hospitalization costs differed significantly by patient source, age group, occupation, payment method, admission year, ICU use, length of stay, number of comorbidities, surgery type and level, concurrent hernia surgeries, bowel resection, additional procedures, mesh use, and ventilator use (all P < 0.05). From 2012 to 2022, the mean hospitalization cost increased from ¥42,388 to ¥73,459, before slightly declining to ¥60,276 in 2024; materials consistently accounted for over 50% of the total cost. Quantile regression revealed that mesh use (β = 25,784 to 36,229), laparoscopic surgery (β = 7,359 to 17,813), and concurrent hernia surgeries (β = 9,409 to 14,447) significantly increased costs across all quantiles (all P < 0.001). Length of stay (β = 543 to 894) and number of comorbidities (β = 424 to 646) were also significantly associated with costs at all quantiles (P < 0.05). Ventilator use was associated with higher costs at the 30th, 40th, 50th, and 90th quantiles, peaking at the 90th (β = 17,088; P < 0.001). Level 4 surgery increased costs significantly from the 10th to 40th quantiles (β = 8,596 to 16,634; all P ≤ 0.040).<h4>Conclusions</h4>Hospitalization costs for PSH repair vary statistically significantly by clinical complexity, surgical approach, socioeconomic status, and procedural resource intensity. These findings highlight the need to incorporate economic considerations into clinical decision-making and healthcare policy.