Cost of Bleeding in Trauma and Complex Cardiac Surgery
Cost of Bleeding in Trauma and Complex Cardiac Surgery
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DOI：
10.1016/j.clinthera.2015.06.007
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发表时间：
2015-09-01
影响因子：
3.2
通讯作者：
Magee, Glenn
中科院分区：
文献类型：
--
作者：
Zbrozek, Arthur;Magee, Glenn
目的：创伤和复杂的心脏手术与出血并发症的高风险相关。需要出血控制措施的患者和不需要出血控制措施的患者之间的成本差异鲜为人知。我们的目标是评估这些环境下患者的护理成本和结果。方法：根据国际疾病分类第九版代码，在高级医院数据库中对2010年1月至2012年12月出院的18岁患者进行回顾性鉴定。这些患者被归类为接受过血液制品的患者(“出血患者”)和未接受血液制品治疗的患者(“非出血患者”)。费用和住院时间(LOS)为零的患者被排除在外。结果：与非出血患者(n=53,727)相比，出血创伤患者(n=8800)的总护理费用(P<；0.001；剔除用于止血的药物费用后，P<；0.001)高出150%，住院LOS(P<；0.001)延长81.3%，重症监护病房(ICU)LOS(P<；0.001)延长65.2%。与非出血患者(n=380,902)相比，出血性复杂心脏手术患者(n=82,832)的总医疗费用高133.2%(P<；0.001；剔除用于止血的药物费用，P<；0.001)，住院LOS长155.6%(P<；0.001)，ICU LOS长89.3%(P<；0.001)。(C)2015年提交人。由爱思唯尔HS期刊出版公司出版。
Purpose: Trauma and complex cardiac surgery are associated with a high risk of bleeding complications. The difference in costs between patients who require bleeding control measures and those who do not is poorly understood. Our goal was to assess the cost of care and outcomes for patients in these settings.Methods: Patients >18 years of age, who were discharged between January 2010 and December 2012, were retrospectively identified in the Premier Hospital Database based on International Classification of Disease, Ninth Revision codes. These patients were categorized as having received blood products ("bleeding patients") or not ("nonbleeding patients"). Patients with costs and length of stay (LOS) of zero were excluded. Differences in treatment costs and outcomes were assessed using univariate analysis and multivariate modeling.Findings: Bleeding trauma patients (n = 8800) had a 150% higher total cost of care (P < 0.001; 146% after excluding costs of agents used for bleeding control, P < 0.001), an 81.3% longer hospital LOS (P < 0.001), and a 65.2% longer intensive care unit (ICU) LOS (P < 0.001) than nonbleeding patients (n = 53,727). Bleeding complex cardiac surgery patients (n = 82,832) had a 133.2% higher total cost of care (P < 0.001; 128.7% after excluding costs of agents used for bleeding control, P < 0.001), a 155.6% longer hospital LOS (P < 0.001), and an 89.3% longer ICU LOS (P < 0.001) than nonbleeding patients (n = 380,902). (C) 2015 The Authors. Published by Elsevier HS Journals, Inc.