与异构输血相关的下游不良结果的成本:回顾性观察性队列研究
Michelle Roets1, David John Sturgess2, Kerstin Hildegard Wyssusek1
1Department of Anaesthesia, Royal Brisbane and Women's Hospital, Faculty of Medicine, University of Queensland, Brisbane, QLD 4006, Australia.
全基性输血 (ABT) 与手术内细胞救援 (ICS) 相比,与更高的成本和更不利的结果有关. 接受包装红细胞 (pRBC) 的患者与接受ICS的患者相比,承担了更大的费用和并发症.
科学领域:
- 输血医学 输血医学
- 卫生经济学 卫生经济学
- 外科手术的结果
背景情况:
- 术后不良结果,称为输血相关免疫调制 (TRIM),与异构输血 (ABT) 有关.
- 术后ABT的财务影响和临床影响往往被低估.
- 在此之前,手术内细胞救援 (ICS) 已经在管理TRIM方面表现出优势.
研究的目的:
- 评估经过ABT后的外科手术期不良结果的成本影响.
- 分析与ICS相关的下游成本.
- 为了突出ABT与ICS的成本影响,基于ICS的已确定的成果效益.
主要方法:
- 在皇家布里斯班和妇女医院对2129名手术患者 (2016-2018) 的回顾性观察研究.
- 纳入标准:仅接受ICS,仅接受全基红细胞 (RBC) 或同时接受红细胞和ICS的患者.
- 使用新型SQL数据库进行数据链接;通过ICD-10代码评估不良结果;用于成本分析的通用线性模型.
主要成果:
- 接受红血细胞和ICS治疗的患者经历了最不利的结果 (37.1%),其次是仅接受红血细胞 (23.7%),仅接受ICS治疗 (16.5%).
- 重症监护室 (ICU) 住院费用是ICS的最低 (10,027澳元),红细胞和ICS的中等 (18,089澳元),红细胞的最高 (26,071澳元).
- 每名患者的平均非包装红细胞成本对ICS (AUD48) 最低,其次是红细胞 (AUD533),红细胞和ICS (AUD819).
结论:
- 与全基性输血相关的重大成本.
- 接受包装红细胞 (pRBC) 的患者比接受ICS治疗的患者面临更多的不良结果和更高的医院费用.
- 调查结果基于追溯数据,需要进行前性验证.
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