Implanted ventricular shunts in the United States: The billion-dollar-a-year cost of hydrocephalus treatment
Implanted ventricular shunts in the United States: The billion-dollar-a-year cost of hydrocephalus treatment
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DOI：
10.1227/01.neu.0000146206.40375.41
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发表时间：
2005-01-01
期刊：
影响因子：
4.8
通讯作者：
Nanda, A
中科院分区：
文献类型：
--
作者：
Patwardhan, RV;Nanda, A
目的：为了描述2000年在诊断，程序，社会经济地位和其他相关data.METHODS方面与脑室分流相关的入院情况：对全国住院患者样本数据库（2000年）进行回顾性分析。我们回顾了745万例患者的入院情况，主要国际疾病分类，第9次修订，程序代码023至0243（心室分流到腹膜，心房，胸膜和泌尿系统的初始放置，修订和删除）;入院列表脑室造口术放置（代码022）被排除在分析之外。入院来源主要为常规（58.8%）和急诊（32.4%）。入院类型主要为择期（43.3%）、急诊（33.2%）和急诊（21.9%）。接受治疗的前三位主要诊断为分流系统故障（40.7%）、非交通性脑积水（16.6%）和交通性脑积水（13.2%）。分流感染是7.2%的住院患者的主要诊断。入院的年龄频率是非参数的，婴儿最高;平均住院时间为8.4 ± 0.2天（标准误范围，0-243天）。最常见的手术是脑室腹腔分流放置（43.4%）和脑室分流置换术（42.8%）; 7.3%的住院患者进行了脑室分流移除，而脑室至胸腔（0.6%）、脑室至循环系统（0.5%）和脑室至泌尿系统（0.05%）分流则很少见。平均成本为35，816 +/-810美元（标准误差范围为137 - 814，748美元）。主要支付者主要是私人保险公司（43.8%），医疗保险（26.0%）和医疗补助（24.5%）。处置方式主要为常规（78.4%，6.5%为家庭保健），住院死亡率为2.7%。有没有在治疗方面的平均家庭income.CONCLUSION社会经济不成比例：脑室分流术作为主要程序构成了一个重要的医疗和经济问题。
OBJECTIVE: To characterize admissions related to ventricular shunts in the year 2000 in terms of diagnoses, procedures, socioeconomic status, and other related data.METHODS: The Nationwide Inpatient Sample database (year 2000) was analyzed retrospectively. We reviewed 7.45 million patient admissions for primary International Classification of Diseases, 9th Revision, procedure codes 023 to 0243 (ventricular shunts to peritoneal, atrial, pleural, and urinary systems for initial placement, revision, and removal); admissions listing ventriculostomy placement (code 022) were excluded from analysis.RESULTS: Five thousand five hundred seventy-four admissions were identified. Admission sources primarily were routine (58.8%) and the emergency department (32.4%). Admission types primarily were elective (43.3%), emergent (33.2%), and urgent (21.9%). The top three primary diagnoses treated were shunt malfunction (40.7%), noncommunicating hydrocephalus (16.6%), and communicating hydrocephalus (13.2%). Shunt infection was the primary diagnosis in 7.2% of admissions. Age frequency of admissions was nonparametric, being highest for infants; the average stay was 8.4 +/- 0.2 days (standard error range, 0-243 d). The most common procedures were ventriculoperitoneal shunt placement (43.4%) and ventricular shunt replacement (42.8%); ventricular shunt removal occurred in 7.3% of admissions, whereas ventricle-to-thorax (0.6%), ventricle-to-circulatory system (0.5%), and ventricle-to-urinary system (0.05%) shunts were rare. Average cost was $35,816 +/- $810 (standard error range, $137-$814,748). Primary payers primarily were private insurers (43.8%), Medicare (26.0%), and Medicaid (24.5%). Disposition mainly was routine (78.4%, with home health care in 6.5%), and inpatient mortality was 2.7%. There was no socioeconomic disproportion in treatment with respect to average household income.CONCLUSION: Ventricular shunts as primary procedures constitute a significant medical and economic problem.