Health and economic outcomes associated with uncontrolled surgical bleeding: a retrospective analysis of the Premier Perspectives Database
Health and economic outcomes associated with uncontrolled surgical bleeding: a retrospective analysis of the Premier Perspectives Database
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DOI：
10.2147/ceor.s86369
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发表时间：
2015-01-01
影响因子：
2.1
通讯作者：
Chang, Eunice
中科院分区：
文献类型：
--
作者：
Corral, Mitra;Ferko, Nicole;Chang, Eunice
背景：手术中出血仍然是常见的现象。关于难以控制的出血和局部可吸收止血药使用的负担的数据很少。本研究旨在评估手术出血不受控制的临床和经济影响，即使在手术中使用止血剂。方法：采用美国Premier Perspectives数据库进行回顾性分析。使用2012年的出院病例来确定8种手术类型中使用止血剂的患者。纳入的患者年龄为bb0 = 18岁，在8例手术中有1例住院，并在手术当天使用止血钳。患者根据手术和是否存在大出血（不受控制）进行分层，尽管使用了止血药。结果是全因住院费用、止血费用、住院时间、再手术和手术相关并发症（如死亡率）。通过卡方检验或t检验检验统计学显著性。采用协方差分析对全因费用和住院时间进行多变量分析。结果：25,048例手术中，14,251例发生大出血事件。尽管使用止血剂治疗，仍有32%-68%的病例发生大出血。使用止血药后出血不控制的患者的全因成本明显高于出血控制的患者（24,203- 61,323美元[非控制]，14,420- 45,593美元[控制]；P < 0.001）。除膀胱切除术和胰腺手术外，所有手术类型的未控制出血组止血药的费用均显著增加。在除膀胱切除术和根治性子宫切除术外的所有手术中，未控制出血组的再手术率和死亡率均显著较高。结论：尽管使用止血剂，术中不受控制的出血是普遍存在的，与控制出血相比，在几种外科手术中，不受控制的出血与更高的医院费用和更差的临床结果相关。对于能够更有效地控制出血、改善预后和减少医院资源使用的新型止血器的需求尚未得到满足。
Background: Bleeding remains a common occurrence in surgery. Data describing the burden of difficult-to-control bleeding and topical absorbable hemostat use are sparse. This study was conducted to estimate the clinical and economic impact that remains associated with uncontrolled surgical bleeding, even when hemostats are used during surgery.Methods: This US retrospective analysis used the Premier Perspectives Database. Hospital discharges from 2012 were used to identify patients treated with hemostats during eight surgery types. Patients were included if they were >= 18 years, had an inpatient hospitalization with one of the eight surgeries, and received a hemostat on the day of surgery. Patients were stratified by procedure and presence or absence of major bleeding (uncontrolled) despite hemostat use. Outcomes were all-cause hospitalization costs, hemostat costs, length of stay, reoperation, and surgery-related complications (eg, mortality). Statistical significance was tested through chi-square or t-tests. Multivariate analyses were conducted for all-cause costs and length of stay using analysis of covariance.Results: Among 25,048 procedures, major bleeding events occurred in 14,251 cases. Despite treatment with hemostats, major bleeding occurred in 32%-68% of cases. All-cause costs were significantly higher in patients with uncontrolled bleeding despite hemostat use versus controlled bleeding (US$24,203-$61,323 [uncontrolled], US$14,420-$45,593 [controlled]; P < 0.001). Hemostat costs were significantly greater in the uncontrolled bleeding cohort for all surgery types except cystectomy and pancreatic surgery. Reoperation and mortality rates were significantly higher in the uncontrolled bleeding cohort in all surgical procedures except cystectomy and radical hysterectomy.Conclusion: Uncontrolled intraoperative bleeding despite hemostat use is prevalent and associated with significantly higher hospital costs and worse clinical outcomes across several surgical procedures compared to controlled bleeding. There is an unmet need for newer hemostats that can more effectively control bleeding, improve outcomes, and reduce hospital resource use.