普罗波镇静并没有改善结肠镜检查质量的测量,而是增加了成本 - - 来自一项基于大量人群的队列研究的研究结果
Sheikh Rahman1,2,3, Lauren E Cipriano2,4,5,3, Cassandra McDonald2
1Division of Gastroenterology, London Health Sciences Centre, Canada.
EClinicalMedicine
|March 18, 2024
概括
在结肠镜检查中使用普罗波镇静剂并没有改善像腺瘤检测率这样的质量指标,但却显著增加了成本. 应重新评估普罗波的常规使用是否具有成本效益和质量结果.
科学领域:
- 胃肠病学 胃肠病学
- 麻醉学 麻醉学
- 卫生经济学 卫生经济学
背景情况:
- 普罗波经常在结肠镜检查过程中用于镇静.
- 结肠镜质量指标和相关成本对于患者护理和医疗保健系统效率至关重要.
研究的目的:
- 评估普罗波镇静与意识镇静对结肠镜质量指标的影响.
- 评估用于结肠镜检查的使用propofol的成本影响.
主要方法:
- 一项基于人口的队列研究分析了加拿大安大略省46,634次结肠镜 (2017年4月至2018年10月).
- 与意识镇静相比较的propofol镇静,评估腺瘤检测率 (ADR),状状聚检测率 (ssPDR),聚检测率 (PDR),内输管率 (CIR) 和穿孔率.
- 使用修改的Poisson回归,调整为患者,程序和医生混因素.
主要成果:
- 在35.2%的病例中使用了普罗波;在64.8%的病例中使用了有意识的镇静剂.
- 普罗波与较低的未经调整的ADR相关 (24.6%与27.0%,p < 0.0001).
- 两组之间没有观察到ssPDR,PDR,CIR或穿孔率的显著差异. 多变量分析显示,使用propofol.没有改善ADR,ssPDR,PDR或CIR.
- 普罗波镇静剂每10万例增加了12730496美元的额外成本.
结论:
- 在结肠镜检查中使用普罗波镇静剂并没有提高关键质量指标.
- 普罗波的使用与医疗保健成本大幅上升有关.
- 基于质量和成本效益,重新评估用于结肠镜检查的常规使用的propofol是合理的.
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