Factors Associated With High Resource Use in Elective Adult Cardiac Surgery From 2005 to 2016.
Factors Associated With High Resource Use in Elective Adult Cardiac Surgery From 2005 to 2016.
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DOI：
10.1016/j.athoracsur.2021.02.059
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Benharash P
中科院分区：
文献类型：
--
作者：
Seo YJ;Sareh S;Hadaya J;Sanaiha Y;Ziaeian B;Shemin RJ;Benharash P
对于可能与成人心脏手术患者高资源利用（HRU）相关的因素，目前仍缺乏共识。我们的目的是确定与涉及择期心脏手术的HRU入院相关的患者、医院和围手术期特征。来自全国住院患者样本的数据用于识别2005年至2016年期间接受冠状动脉旁路移植术（CABG），瓣膜置换术和瓣膜修复术的患者。HRU的入院定义为总住院费用最高的十分位数。多变量回归分析用于确定与HRU相关的因素。估计有1，750，253例住院编码为择期心脏手术。中位住院费用为34.7K美元（IQR 26.8K-47.1K美元），HRU（N= 175，025）截止值为66，029美元。虽然HRU患者占入院人数的10%，但他们占累计费用的25%。在多变量回归分析中，HRU的预测因素包括女性、年龄较大、合并症负担较高、非白人和最高收入四分位数。与HRU相关的医院因素是CABG和瓣膜手术的低容量医院。在术后结局中，死亡率、感染并发症、体外膜肺氧合使用和住院时间> 8天与HRU发生率较高相关。在这项针对择期心脏手术患者的全国性研究中，几个重要的患者和医院因素，包括患者种族、合并症、术后感染并发症和低医院手术量，被确定为HRU的预测因素。这些高度预测性的因素可用于基准目的和手术计划的改进。
Lack of consensus remains about factors that may be associated with high resource utilization (HRU) in adult cardiac surgical patients. We aimed to identify patient, hospital, and perioperative characteristics associated with HRU admissions involving elective cardiac operations. Data from the National Inpatient Sample was used to identify patients who underwent coronary artery bypass graft (CABG), valve replacement, and valve repair operations between 2005 and 2016. Admissions with HRU were defined as those in the highest decile for total hospital costs. Multivariable regressions were used to identify factors associated with HRU. An estimated 1,750,253 hospitalizations coded for elective cardiac operations. The median hospitalization cost was $34.7K (IQR $26.8K - $47.1K), with HRU (N=175,025) cutoff at $66,029. Although HRU patients comprised 10% of admissions, they accounted for 25% of cumulative costs. On multivariable regression, patient characteristics predictive of HRU included female sex, older age, higher comorbidity burden, non-white race, and highest income quartile. Hospital factors associated with HRU were low volume hospitals for both CABG and valvular operations. Among postoperative outcomes, mortality, infectious complication, extracorporeal membrane oxygenation use, and hospitalization > 8 days were associated with greater odds of HRU. In this nationwide study of elective cardiac surgical patients, several important patient and hospital factors, including patient race, comorbidities, postoperative infectious complications, and low hospital operative volume were identified as predictors of HRU. These highly predictive factors may be used for benchmarking purposes and improvement in surgical planning.
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影响因子：
4.6
作者：
Brown, Phillip P.;Kugelmass, Aaron D.;Simon, April W.
通讯作者：
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影响因子：
0.3
作者：
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影响因子：
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作者：
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DOI：
10.1161/circoutcomes.111.963223
发表时间：
2011-11-01
影响因子：
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作者：
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通讯作者：
Benavidez, Oscar J.
影响因子：
3.4
作者：
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通讯作者：
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