Intensive cave unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection
Intensive cave unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection
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DOI：
10.1097/00003246-200104000-00012
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发表时间：
2001-04-01
影响因子：
8.8
通讯作者：
Lipsett, PA
中科院分区：
文献类型：
--
作者：
Dimick, JB;Pronovost, PJ;Lipsett, PA
目的：确定重症监护病房 (ICU) 医生每日查房是否与食管切除术后的临床和经济结果相关。设计：ICU 信息来自一项前瞻性调查，并与马里兰州健康服务成本审查委员会的回顾性患者数据相关联。主要结果变量是院内死亡率、住院时间、住院费用和食管切除术后的并发症。背景：1994-1998 年研究期间，马里兰州进行食管切除术的非联邦急症护理医院（n = 35 家医院）。患者：1994 年至 1998 年在马里兰州接受食管切除术的成年患者（n = 366 名患者），干预措施：是否存在 ICU 医生每日查房。测量和主要结果：根据患者病例组合和其他医院特征进行调整后，ICU 医生缺乏每日查房与住院时间增加 73%（7 天；95% 置信区间 [CI]，1-15；p = 0.012）和住院总费用增加 61%（8,839 美元；95% CI，$）独立相关。 1,674-$19,192；p = .013），但与院内死亡率没有关联。此外，以下术后并发症与缺乏 ICU 医生每日查房独立相关：肺功能不全（比值比 [OR]，4.0；CI，1.4-11.0）、肾功能衰竭（OR，6.3；CI，1.4-28.7）、误吸（OR，1.7；CI，1.0-2.8）和重新插管（OR，2.8；CI， 1.5-5.2).结论：ICU 医生每日查房与缩短住院时间、降低住院费用以及降低食管切除术后术后并发症的发生频率相关。医疗保健提供者和政策制定者应利用这些信息来帮助提高护理质量并降低接受高风险手术的患者的费用。
Objective: To determine whether having daily rounds by an intensive care unit (ICU) physician is associated with clinical and economic outcomes after esophageal resection.Design:ICU information was obtained from a prospective survey and linked to retrospective patient data from the Maryland Health Cervices Cost Review Commission. The main outcome variables were in-hospital mortality rate, length of stay, hospital cost, and complications after esophageal resection.Setting: Nonfederal acute care hospitals in Maryland that performed esophageal resection (n = 35 hospitals) during the study period, 1994-1998.Patients: Adult patients who underwent esophageal resection in Maryland (n = 366 patients) from 1994 to 1998, Interventions: Presence vs. absence of daily rounds by an ICU physician.Measurements and Main Results:After adjusting for patient case-mix and other hospital characteristics, lack of daily rounds by an ICU physician was independently associated with a 73% increase in hospital length Of stay (7 days; 95% confidence interval [CI], 1-15; p = .012) and a 61% increase in total hospital cost ($8,839; 95% CI, $ 1,674-$19,192; p = .013), but there was no association with in-hospital mortality rate. In addition, the following postoperative complications were independently associated with lack of daily rounds by an ICU physician: pulmonary insufficiency (odds ratio [OR], 4.0; CI, 1.4-11.0), renal failure (OR, 6.3; CI, 1.4-28.7), aspiration (OR, 1.7; CI, 1.0-2.8), and reintubation (OR, 2.8; CI, 1.5-5.2).Conclusions: Having daily rounds by an ICU physician is associated with shorter lengths of stay, lower hospital cost, and decreased frequency of postoperative complications after esophageal resection, Healthcare providers and policymakers should use this information to help improve quality of care and reduce costs for patients undergoing high-risk surgical procedures.