Endoscopic stenting versus surgical colostomy for the management of malignant colonic obstruction: comparison of hospital costs and clinical outcomes.
Endoscopic stenting versus surgical colostomy for the management of malignant colonic obstruction: comparison of hospital costs and clinical outcomes.
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DOI：
10.1007/s00464-010-1523-y
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发表时间：
2011-07
影响因子：
3.1
通讯作者：
Kim, Micheline
中科院分区：
文献类型：
--
作者：
Varadarajulu, Shyam;Roy, Ann;Lopes, Tercio;Drelichman, Ernesto R.;Kim, Micheline
尽管支架置入术越来越多，但结肠造口仍被认为是紧急解除恶性结肠梗阻(MCO)的金标准。这项研究旨在比较接受结肠造口和支架置入术的MCO患者的住院费用和临床结果。对医疗保险提供者分析和审查(MedPAR)数据集进行了一项回顾性索赔分析，以确定因结肠造口或支架置入治疗结肠癌而住院的患者(2007-2008年)。使用MedPAR评估的结果比较了两种技术的总住院时间(LOS)和相关成本。因为MedPAR是一个声称的数据集，不能提供患者水平的结果，所以进行了一项单一机构的回溯性病例对照研究，在同一时期，每个支架放置患者与两名结肠造口患者匹配。结果测量(机构数据)被用来比较两个队列之间的治疗成功率、术后损失和再干预。MedPAR的数据评估了778例支架置入和5868例结肠造口住院治疗。两组患者在性别、年龄分布或合并症方面没有差异。与结肠造口术相比，支架置入的中位数LOS(8天对12天；P<；0.0001)和中位成本(15,071美元对24,695美元；P<；(0.001))显著减少。城市医院和乡村医院(84%比16%；P<0.0001)、教学医院和非教学医院(56%比44%；P<0.0058)以及大型医院和小型机构(平均床位容量，331比227；P<0.0001)更常进行支架置入。机构数据包括12名接受支架置入的患者和24名接受结肠造口的患者。虽然两种方法在技术上都是成功的，但支架置入术的术后中位数LOS(2.17vs.10.58d；p=0.0004)和并发症的再住院率(0%vs.25%；p=0.01.)明显较低。虽然结肠造口术和支架置入术的技术和临床结果相似，但支架置入术的费用更低，LOS更短，并发症更少。在城市地区的大型教学医院以外的地方推广支架置入术作为治疗MCO的一种方法是很重要的，因为它对患者护理和资源使用有影响。本文的在线版本(doi：10.1007/s00464-0101523-y)包含补充材料，可供授权用户使用。
Although stent placement is increasingly performed, colostomy still is considered the gold standard for emergent relief of malignant colonic obstruction (MCO). This study aimed to compare hospital costs and clinical outcomes between patients undergoing colostomy and those undergoing stenting for the management of MCO. A retrospective claims analysis of the Medicare Provider Analysis and Review (MedPAR) data set was conducted to identify inpatient hospitalizations for colostomy or stent placement for the treatment of colon cancer (2007–2008). The outcomes evaluated using MedPAR compared the total length of hospital stay (LOS) and the costs associated with both techniques. Because MedPAR is a claims data set that does not provide outcomes at a patient level, a single-institution retrospective case–control study was conducted in which each stent placement patient was matched with two colostomy patients during the same period. Outcome measures (institutional data) were used to compare rates of treatment success, postprocedure LOS, and reinterventions between the two cohorts. The MedPAR data evaluated 778 stent placements and 5,868 colostomy hospitalizations. There were no differences in gender, age distribution, or comorbidity between the two groups. Compared with colostomy, the median LOS (8 vs. 12 days; p < 0.0001) and the median cost ($15,071 vs. $24,695; p < 0.001) per claim were significantly less for stent placement. Stent placement was more commonly performed at urban versus rural hospitals (84% vs. 16%; p < 0.0001), teaching versus nonteaching hospitals (56% vs. 44%; p = 0.0058) and larger versus smaller institutions (mean bed capacity, 331 vs. 227; p < 0.0001). The institution data included 12 patients who underwent stent placement and 24 who underwent colostomy. Although both methods were technically successful, the median postprocedure LOS (2.17 vs. 10.58 days; p = 0.0004) and the rate of readmissions for complications (0% vs. 25%; p = 0.01) were significantly lower for stent placement. Although the technical and clinical outcomes for colostomy and stent placement appear comparable, stent placement is less costly and associated with shorter LOS and fewer complications. Dissemination of stent placement beyond large teaching hospitals located in urban areas as a treatment for MCO is important given its implications for patient care and resource use. The online version of this article (doi:10.1007/s00464-010-1523-y) contains supplementary material, which is available to authorized users.
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影响因子：
2.2
作者：
WONG, RW;RAPPAPORT, WD;HUNTER, GC
通讯作者：
HUNTER, GC
影响因子：
19.7
作者：
Binkert, CA;Ledermann, H;Zollikofer, CL
通讯作者：
Zollikofer, CL
DOI：
10.1007/s00464-003-8109-x
发表时间：
2004-03-01
影响因子：
3.1
作者：
Xinopoulos, D;Dimitroulopoulos, D;Paraskevas, E
通讯作者：
Paraskevas, E
影响因子：
6.2
作者：
GREENWALD, P
通讯作者：
GREENWALD, P
影响因子：
3.9
作者：
SPRANGERS, MAG;TAAL, BG;TEVELDE, A
通讯作者：
TEVELDE, A