Outcomes of inpatients with and without sickle cell disease after high-volume surgical procedures.
Outcomes of inpatients with and without sickle cell disease after high-volume surgical procedures.
复制标题
患有和不患有镰状细胞病的住院患者在大容量外科手术后的结果。
DOI：
10.1002/ajh.21520
复制
发表时间：
2009
影响因子：
12.8
通讯作者：
Reed,ShelbyD
中科院分区：
文献类型：
--
作者：
Dinan,MichaelaA;Chou,Chia-Hung;Hammill,BradleyG;Graham,FeliciaL;Schulman,KevinA;Telen,MarilynJ;Reed,ShelbyD
在这项研究中，我们检查了接受大容量外科手术的镰状细胞病（SCD）患者和非SCD患者住院治疗的住院费用、住院时间和住院死亡率的差异。我们使用临床分类软件（CCS）的代码，以确定在2002年至2005年全国住院病人的医疗保健成本和利用项目的病人谁经历了胆囊切除术或髋关节置换术的样本出院。我们将非SCD队列限制在SCD患者接受相同手术的医院。我们使用概括统计和广义线性回归分析来比较住院患者的结局，以调整患者、医院和手术特征。总体而言，接受相同手术的SCD手术患者的中位年龄比未接受SCD手术的患者的中位年龄小三十多岁。考虑到年龄差异，我们将分析限制在18至64岁的患者中。尽管如此，接受胆囊切除术或髋关节置换术的SCD患者比未接受SCD的患者分别年轻12.1岁和14.4岁，住院时间延长73%和82%，每次出院的费用分别高出46%和40%。这些手术的住院死亡率较低，胆囊切除术为0.6%，髋关节置换术为0.2%，并且在有和无SCD的患者之间没有显著差异。多变量回归分析显示，SCD患者的住院费用较高主要归因于住院时间较长。接受胆囊切除术或髋关节置换术的SCD患者比无SCD患者需要更多的医疗保健资源。Am.血液学杂志2009.© 2009 Wiley利斯公司
In this study, we examined differences in inpatient costs, length of stay, and in‐hospital mortality between hospitalizations for patients with and without sickle cell disease (SCD) undergoing high‐volume surgical procedures. We used Clinical Classification Software (CCS) codes to identify discharges in the 2002–2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for patients who had undergone either cholecystectomy or hip replacement. We limited the non‐SCD cohort to hospitals where patients with SCD had undergone the same procedure. We compared inpatient outcomes using summary statistics and generalized linear regression analysis to adjust for patient, hospital, and procedural characteristics. Overall, the median age of surgical patients with SCD was more than three decades less than the median age of patients without SCD undergoing the same procedure. In recognition of the age disparity, we limited the analyses to patients aged 18 to 64 years. Nonetheless, patients with SCD undergoing cholecystectomy or hip replacement were 12.1 and 14.4 years younger, had inpatient stays that were 73% and 82% longer, and incurred costs that were 46% and 40% higher per discharge than patients without SCD, respectively. Inpatient mortality for these procedures was low, ∼0.6% for cholecystectomy and 0.2% for hip replacement and did not differ significantly between patients with and without SCD. Multivariable regression analyses revealed that higher inpatient costs among patients with SCD were primarily attributable to longer hospital stays. Patients with SCD who underwent cholecystectomy or hip replacement required more health care resources than patients without SCD. Am. J. Hematol. 2009. © 2009 Wiley‐Liss, Inc.