更多的问题,更多的钱:在结直肠手术后识别和预测高成本的救援
Ira L Leeds1, Miranda S Moore1, Kurt Schultz1
1Yale School of Medicine, Department of Surgery, Division of Colon & Rectal Surgery, New Haven, CT, United States.
Surgery open science
|November 29, 2023
概括
结肠直肠手术后的高成本救援显著增加了医疗保健成本,由重新手术驱动. 优先考虑减少重新操作的策略是成本意识护理的关键.
科学领域:
- 手术成果研究的研究结果.
- 卫生经济学 卫生经济学
- 患者安全 患者安全
背景情况:
- 选择性手术后的成功救援与更高的医疗保健费用有关.
- 救援成本的变化表明有机会进行有针对性的节省成本的干预.
- 预测高成本的救援事件对于优化结直肠外科手术的资源配置至关重要.
研究的目的:
- 确定与选择性结直肠手术后高成本救援事件相关的术前临床预测因素.
- 区分低成本和高成本的救援场景,以告知有针对性的干预.
主要方法:
- 从国家住院患者样本 (2016-2021) 中分析了接受选择性集体切除或分体切除的成年患者.
- 患者分为三组:无事件恢复,低成本救援和高成本救援.
- 利用多变量波桑回归来确定高成本救援的预测因素.
主要成果:
- 被救出的患者占总样本的4.8%,平均成本增加了25.544美元.
- 高成本救援患者的住院总费用中位数为95,926美元,远高于低成本救援 (34,811美元) 和无事件恢复 (16,751美元).
- 重新操作是高成本救援的重要独立预测因素 (RR=3.29与CHF,RR=2.29没有CHF).
结论:
- 在结直肠外科手术中,高成本的救援以大量的医疗保健利用和更高的重新手术可能性为特征.
- 旨在减轻重新手术相关并发症的预防性策略对于实现成本意识的手术护理至关重要.
- 了解高成本救援的预测因素可以指导资源分配和改善患者的治疗结果.
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