Health Care Costs of Post-traumatic Osteomyelitis in China: Current Situation and Influencing Factors
Health Care Costs of Post-traumatic Osteomyelitis in China: Current Situation and Influencing Factors
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中国创伤后骨髓炎的医疗费用：现状及影响因素。
DOI：
10.1016/j.jss.2019.10.008
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发表时间：
2020-03-01
影响因子：
2.2
通讯作者：
Yu, Bin
中科院分区：
文献类型：
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作者：
Jiang, Nan;Wu, Hang-Tian;Yu, Bin
背景：目前，有关四肢创伤后骨髓炎(OM)患者的经济负担的信息非常有限。本研究旨在调查南方地区四肢创伤后骨肉瘤住院患者的直接医疗费用及利用情况，分析其构成比及影响因素。方法：在电子病历系统中检索2013-2016年间在我科接受手术治疗的四肢创伤后骨肉瘤患者。他们在住院期间发生的直接医疗费用的数据被收集在六个主要类别(服务、诊断、治疗、材料、药品和杂项费用)。结果：共纳入创伤后OM患者278例，对照组10,420例。创伤后OM住院患者的平均费用为10,504美元，是非创伤后OM患者(2,189美元，P<；0.001)的4.8倍。材料类的直接费用占比最大(61%)，其次是药品(12%)和治疗(11%)。创伤后OM患者住院的中位数为1次，平均住院时间为22天。对创伤后OM住院患者医疗费用影响最大的因素是使用外固定器(使用外固定器的人为16,016美元，不使用外固定器的人为4,956美元，P<；0.001)，外固定器的类型(环状固定器为19,563美元，轨道固定器为14,966美元，P<；0.001)，感染部位(胫骨13,755美元，股骨14,216美元，跟骨5,673美元，P<；0.001)；0.001)和感染相关损伤类型(开放性骨折后感染12,890美元，闭合性骨折后感染8,087美元，P=0.001)。结论：四肢创伤后OM住院患者的直接医疗费用中意外地有很大比例用于支付外固定器，药物和治疗费用仅占总医疗费用的十分之一多一点。外固定器的使用、外固定器类型、感染部位、感染相关损伤类型直接影响医疗费用。(C)2019 Elsevier Inc.保留所有权利。
Background: Currently, very limited information is available regarding the economic burdens of patients with extremity post-traumatic osteomyelitis (OM). This study aimed to investigate direct health care costs and utilization for inpatients with extremity post-traumatic OM and analyze its constituent ratios and influencing factors in Southern China.Methods: We searched in the electronic medical record system for inpatients who had received surgical interventions at our department between 2013 and 2016 for extremity post-traumatic OM. Data of direct health care costs incurred during their hospitalizations were collected in six main categories (service, diagnosis, treatment, materials, pharmaceuticals, and miscellaneous expenses). In addition, data of total medical costs for contemporaneous inpatients with non-post-traumatic OM were also collected as controls.Results: A total of 278 post-traumatic OM and 10,420 controls were included. The median cost for the post-traumatic OM inpatients was $10,504 US dollars, 4.8-fold higher than that for those with non-post-traumatic OM ($2189, P < 0.001). The direct cost in the category of materials accounted for the largest proportion (61%), followed by that in pharmaceuticals (12%) and treatment (11%). The median number of hospital admissions for post-traumatic OM patients was 1 time, with a median length-of-stay of 22 d. The most influencing factors for the health care costs of the post-traumatic OM inpatients were use of an external fixator ($16,016 for those who used versus $4956 for those who did not, P < 0.001), external fixator type ($19,563 for ring fixator versus $14,966 for rail fixator, P < 0.001), infection site ($13,755 for tibia, $14,216 for femur and $5673 for calcaneus, P < 0.001), and infection-associated injury type ($12,890 for infection after open fracture versus $8087 for infection after closed fracture, P = 0.001).Conclusions: An unexpectedly large proportion of the direct health care costs for inpatients with extremity post-traumatic OM went to cover an external fixator, with expenses for pharmaceuticals and treatment accounting for only a little more than the tenth of the total health care costs. Use of external fixator, external fixator type, infection site, and infection-associated injury type directly influenced the health care costs. (C) 2019 Elsevier Inc. All rights reserved.