Economic impact of failed or delayed primary repair of bladder exstrophy: Differences in cost of hospitalization
Economic impact of failed or delayed primary repair of bladder exstrophy: Differences in cost of hospitalization
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DOI：
10.1016/j.juro.2007.09.093
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发表时间：
2008-02-01
影响因子：
6.6
通讯作者：
Gearhart, John P.
中科院分区：
文献类型：
--
作者：
Nelson, Caleb P.;North, Amanda C.;Gearhart, John P.
目的：膀胱外翻和新生儿一期缝合失败或延迟一期修复的患者功能结局不佳。我们试图确定这些患者是否也有昂贵的，更多的资源密集型住院相比，谁接受新生儿一期close.Materials和方法的患者：我们回顾了医院的编码记录，以确定谁在约翰霍普金斯医院1997年和2006年之间进行手术修复的经典膀胱外翻的患者，并获得每次住院的收费记录。医院收费总额（不包括专业费用）按2005年的通货膨胀率调整。结果：对80例典型外翻畸形的手术结果进行分析。共有34例手术为新生儿一期修复，15例为延迟一期修复，31例为既往修复失败的再闭合。所有接受延迟一期修复和再闭合的患者都接受了截骨术，而接受新生儿一期修复的患者只有21%。总体平均通货膨胀调整住院费用为66，348美元+/-26，625美元（范围为29，689美元至179，403美元）。新生儿闭合的成本（平均费用为53，188 +/-15，086美元）明显低于再闭合（71，621 +/-19，366美元）或延迟一期闭合（85，278 +/-42，354美元，p <0.0001）。在回归模型中控制多个变量显示，与费用相关的主要因素是手术时间、重症监护室天数和住院时间。新生儿手术组的住院时间和手术时间明显较短，这可能是该组费用较低的原因（尽管重症监护室使用率较高）。平均住院费用和平均住院时间增加，在研究periods.Conclusions：初级新生儿外翻修复术与较低的手术住院费用相比，延迟初级修复和再闭合。结合之前的临床结果数据，这些数据重申了尽可能实现成功的新生儿初始缝合的至关重要性。
Purpose: Patients with bladder exstrophy and failed primary newborn closure or who undergo delayed primary repair have suboptimal functional outcomes. We sought to determine whether these patients also have costlier, more resource intensive hospitalizations compared to patients who undergo neonatal primary closure.Materials and Methods: We reviewed hospital coding records to identify patients who underwent surgical repair of classic bladder exstrophy at The Johns Hopkins Hospital between 1997 and 2006, and obtained charge records for each hospitalization. Total hospital charges (excluding professional fees) were inflation adjusted to year 2005 dollars. Cases were identified as newborn primary repair, delayed primary repair or reclosure of failed prior repair.Results: Results of classic exstrophy repair were analyzed in 80 patients. A total of 34 procedures were newborn primary repairs, 15 were delayed primary repairs and 31 were reclosures of failed prior repair. All of the patients undergoing delayed primary repairs and reclosures underwent osteotomy, compared to only 21% of those undergoing newborn primary repair. Overall mean inflation adjusted hospitalization charge was $66,348 +/- $26,625 (range $29,689 to $179,403). Newborn closures were significantly less costly (mean charge $53,188 +/- $15,086) than either reclosure ($71,621 +/- $19,366) or delayed primary closure ($85,278 +/- $42,354, p < 0.0001). Controlling for multiple variables in a regression model showed that the primary factors associated with charges were operative time, days in intensive care unit and length of stay. Length of stay and operative times were significantly shorter in the newborn surgical group, likely accounting for the lower costs in this group (despite higher intensive care unit use). Mean hospital charges and mean length of stay increased during the study period.Conclusions: Primary newborn exstrophy repair is associated with lower surgical hospitalization costs compared to delayed primary repair and reclosure. Combined with previous data on clinical outcomes, these data reiterate the paramount importance of achieving a successful initial newborn closure whenever possible.