较长的患者旅行距离与复杂的大动脉手术后的外科和一年成本增加有关
Zach M Feldman1, Xinyan Zheng2, Jialin Mao2
1Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Annals of vascular surgery
|June 24, 2023
概括
为了进行复杂的大动脉手术,需要远程旅行的患者需要支付更高的费用,包括手术费用和第一年的综合费用. 然而,旅行距离没有影响再干预率,这表明需要对这些患者进行护理协调.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 医学经济学 医学经济学
背景情况:
- 复杂的大动脉手术的区域化越来越多,导致患者的旅行负担越来越大.
- 较长的旅行距离与重大手术的较差结果有关,但对重新干预和成本的影响尚不清楚.
- 这项研究调查了患者旅行距离和复杂的大动脉手术后的长期结果之间的关联,包括成本和重新干预.
研究的目的:
- 评估患者旅行距离和复杂的大动脉手术后的长期结果之间的关联.
- 评估旅行距离对再干预率和医疗保健成本的影响.
- 确定改善长途旅行患者护理协调的潜在领域.
主要方法:
- 对接受复杂的内血管大动脉修复或开放腹腔大动脉动脉瘤修复的患者的回顾性审查.
- 按农村-城市通勤区人口密度类别划分旅行距离的分层.人口密度类别.
- 利用多项逻辑回归,负二项和零膨胀的波桑模型来分析成本,成像和重新干预.
主要成果:
- 包括8,782名患者;中位数旅行距离为22.8英里.
- 远程旅行的患者更有可能是女性,并且之前曾经接受过大动脉手术.
- 旅行距离的增加与更高的指数程序成本 (aOR 2.34),成像成本 (aOR 1.55) 和第一年的综合成本 (aOR 2.06) 相关联,但不是再干预率.
结论:
- 为了进行复杂的大动脉手术,需要前往更远的地方的患者面临更高的手术费用和第一年的综合性费用.
- 旅行距离没有显著影响重复干预或术后成像研究的数量.
- 针对这些患者加强护理协调可能会改善结果并减少医疗保健系统的负担.
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