Inpatient Versus Outpatient Management of Negative Pressure Wound Therapy in Pediatric Patients.
Inpatient Versus Outpatient Management of Negative Pressure Wound Therapy in Pediatric Patients.
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DOI：
10.1016/j.jss.2020.04.025
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发表时间：
2020-05
期刊：
影响因子：
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通讯作者：
Katherine B. Santosa;A. Keane;Matthew Keller;M. Olsen;Erika D. Sears;Alison K. Snyder-Warwick
中科院分区：
文献类型：
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作者：
Katherine B. Santosa;A. Keane;Matthew Keller;M. Olsen;Erika D. Sears;Alison K. Snyder-Warwick
背景负压伤口治疗（NPWT）通常用于管理儿科人群的复杂伤口。使用最近开发的便携式NPWT设备，提供者有机会将NPWT过渡到门诊环境。然而，没有研究描述儿科患者的门诊NPWT。因此，我们研究的目的是利用人群水平分析来提高我们目前对儿科患者门诊NPWT使用的认识。材料和方法我们分析了2006年至2014年Truven Health Analytics MarketScan商业索赔数据库，以识别接受NPWT治疗的儿童。我们比较了患者特征、适应症、NPWT前后的并发症、NPWT启动后30天内的医疗保健利用情况以及主要作为门诊患者与住院患者接受NPWT治疗的患者的医疗保健费用概况。门诊NPWT定义为住院期间编码的NPWT ≤ 50%的患者，而住院NPWT定义为NPWT> 50%的患者。结果我们确定了3184例患者（1621例住院患者和1563例门诊患者），年龄为0-17岁，从2006年到2014年接受了NPWT治疗。门诊NPWT适用于多种年龄、合并症和适应症，并发症发生率较低（2.4%）。在控制血液学合并症和适应症后，与住院治疗（15，233.21美元）相比，门诊NPWT与较低的并发症风险（比值比：0.57，95%置信区间0.38-0.86）和较低的中位总成本（5602.03美元）相关。结论：儿科患者的门诊NPWT管理与低并发症发生率相关。有必要进行额外的研究，以确定NPWT在儿科人群中的最具成本效益的总体治疗环境。
Background Negative pressure wound therapy (NPWT) is commonly used to manage complex wounds in the pediatric population. With recently developed portable NPWT devices, providers have the opportunity to transition NPWT to the outpatient setting. However, there are no studies describing outpatient NPWT in pediatric patients. Therefore, the purpose of our study was to leverage a population-level analysis to advance our current knowledge about outpatient NPWT use in pediatric patients. Materials and methods We analyzed the Truven Health Analytics MarketScan Commercial Claims Database from 2006 to 2014 to identify children treated with NPWT. We compared patient characteristics, indications, complications before and after NPWT, health care utilization within 30 d of NPWT initiation, and health care cost profile of patients treated with NPWT primarily as outpatients versus inpatients. Outpatient NPWT was defined as patients with≤ 50% of NPWT coded during an inpatient hospitalization, whereas inpatient NPWT was defined as patients with> 50% of NPWT. Results We identified 3184 patients (1621 inpatients and 1563 outpatients) aged 0-17 y, who were treated with NPWT from 2006 to 2014. Outpatient NPWT was implemented across multiple ages, comorbidities, and indications, with a low complication rate (2.4%). After controlling for hematologic comorbidity and indications, outpatient NPWT was associated with lower risk of complications (odds ratio: 0.57, 95% confidence interval 0.38-0.86) and lower median total costs ($5602.03) compared with inpatient ($15,233.21) therapy. Conclusions Outpatient NPWT management in pediatric patients was associated with low complication rates. Additional studies are necessary to determine the most overall cost-effective treatment setting for NPWT in the pediatric population.