Factors Associated with Inpatient Thoracentesis Procedure Quality at University Hospitals
Factors Associated with Inpatient Thoracentesis Procedure Quality at University Hospitals
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DOI：
10.1016/s1553-7250(16)42004-0
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发表时间：
2016-01-01
影响因子：
2.3
通讯作者：
Barsuk, Jeffrey H.
中科院分区：
文献类型：
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作者：
Kozmic, Sarah E.;Wayne, Diane B.;Barsuk, Jeffrey H.
背景：内科医生越来越多地将胸腔穿刺术应用于介入放射学(IR)，而不是在床边进行。方法：对参与大学卫生系统联盟(UHC)数据库的医院从2010年1月到2013年9月期间接受胸腔穿刺术的患者进行了行政数据库审查。结果：在234家UHC医院的99,509名患者中，共有113,860人入院，132,472例患者进行了胸腔穿刺术。IR进行了43,783例(33%)胸腔穿刺术；药物，22,243例(17%)；肺，26,887例(20%)。医源性气胸的发生率：IR组为2.8%，药物组为2.9%，肺部组为3.1%。在控制了临床相关因素后，内科和肺科患者发生医源性气胸的风险与IR患者相同。在控制了临床协变量后，与IR入院相比，药物入院和肺部手术入院的费用显著降低(p<；0.001)。接受IR手术的入院患者的平均LOS为14.1天，内科患者为13.2天，肺部患者为15.9天。在对照模型中，与IR相比，药物和肺部手术入院的住院天数较少(P<；0.001)。结论：药物入院和床边胸腔穿刺术与IR手术一样安全，成本更低。如果使用便携式超声，将IR胸腔穿刺术转移到床边可能是降低医院成本同时确保高质量患者护理的潜在方法。
Background: Physicians increasingly refer thoracentesis procedures to interventional radiology (IR) rather than performing them at the bedside. Factors associated with thoracentesis procedures at university hospitals were studied to determine clinical outcomes by provider specialty.Methods: An administrative database review was performed of patients who underwent an inpatient thoracentesis procedure in hospitals participating in the University HealthSystem Consortium (UHC) Database from January 2010 through September 2013. The incidence of iatrogenic pneumothorax, mean total hospital costs, and mean length of stay (LOS) were compared by clinical specialty.Results: There were 113,860 admissions with 132,472 thoracentesis procedures performed on 99,509 patients at 234 UHC hospitals. IR performed 43,783 (33%) thoracentesis procedures; medicine, 22,243 (17%); and pulmonary, 26,887 (20%). The incidence of iatrogenic pneumothorax was 2.8% for IR, 2.9% for medicine, and 3.1% for pulmonary. Medicine and pulmonary had equivalent risk of iatrogenic pneumothorax compared to IR after controlling for clinical covariates. Admissions with medicine and pulmonary procedures were associated with significantly lower costs compared to IR admissions (p < 0.001) after controlling for clinical covariates. Admissions with IR procedures had a mean LOS of 14.1 days; medicine, 13.2 days; and pulmonary, 15.9 days. Admissions with medicine and pulmonary procedures were associated with fewer hospital days when compared to IR in the controlled model (p < 0.001).Conclusion: Admissions with medicine and pulmonary bedside thoracentesis procedures are as safe and less costly than IR procedures. Shifting IR thoracentesis procedures to the bedside might be a potential way to reduce hospital costs while still ensuring high-quality patient care, provided that portable ultrasound is used.