Impact of postoperative complications on hospital costs following the Norwood operation.
Impact of postoperative complications on hospital costs following the Norwood operation.
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DOI：
10.1017/s1047951115002498
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发表时间：
2016-10
影响因子：
1
通讯作者：
Scheurer MA
中科院分区：
文献类型：
--
作者：
McHugh KE;Pasquali SK;Hall MA;Scheurer MA
接受诺伍德手术的患者消耗了大量的医疗资源；然而，缺乏有关影响住院费用因素的详细信息。我们评估了术后并发症与住院费用的关联。在本研究中，我们利用了一个独特的数据集，其中包括从儿科心脏网络单心室重建试验中前瞻性收集的临床数据，这些数据在患者层面与试验期间参与儿童医院协会病例混合数据库的 10 家医院的成本数据相关联。使用线性回归对并发症和费用之间的关系进行建模，考虑到费用的偏态分布，并根据中心内聚类和基线患者特征进行调整。数据集之间总共匹配了 334 条符合条件的 Norwood 记录 (97.5%)。总体而言，82% 的患者至少患有一种并发症（中位数为 2；范围为 0 到 33）。出现并发症的患者术后住院时间较长（25 天与 12 天，p < 0.001），呼吸机总天数较多（7 天与 5 天，p < 0.001），院内死亡率较高（17.6% vs 3.4%，p < 0.006）。有并发症的患者的平均调整后住院费用为 190,689 美元（95% CI $111,344–$326,577），而无并发症的患者的平均调整后住院费用为 120,584 美元（95% CI $69,246–$209,983）（p = 0.002）。费用随着并发症数量的增加而增加（1-2 种并发症 = 132,800 美元，3-4 种并发症 = 182,353 美元，⩾5 种并发症 = 309,372 美元 [p < 0.001]）。临床试验和成本数据的合并数据集表明，诺伍德手术后术后并发症很常见，并且与较差的临床结果和较高的成本相关。减少该人群并发症的努力可能会改善结果并节省成本。
Patients undergoing the Norwood operation consume considerable healthcare resources; however, detailed information regarding factors impacting hospitalisation costs is lacking. We evaluated the association of postoperative complications with hospital costs. In the present study, we utilised a unique data set consisting of prospectively collected clinical data from the Pediatric Heart Network Single Ventricle Reconstruction trial linked at the patient level with cost data for 10 hospitals participating in the Children’s Hospital Association Case Mix database during the trial period. The relationship between complications and cost was modelled using linear regression, accounting for the skewed distribution of cost, adjusting for within-centre clustering and baseline patient characteristics. A total of 334 eligible Norwood records (97.5%) were matched between data sets. Overall, 82% suffered from at least one complication (median 2; with a range from 0 to 33). Those with complications had longer postoperative length of stay (25 versus 12 days, p < 0.001), more total ventilator days (7 versus 5 days, p < 0.001), and higher in-hospital mortality (17.6 versus 3.4%, p < 0.006). Mean adjusted hospital cost in those with a complication was $190,689 (95% CI $111,344–$326,577) versus $120,584 (95% CI $69,246–$209,983) in those without complications (p = 0.002). Costs increased with the number of complications (1–2 complications = $132,800 versus 3–4 complications = $182,353 versus ⩾5 complications = $309,372 [p < 0.001]). This merged data set of clinical trial and cost data demonstrated that postoperative complications are common following the Norwood operation and are associated with worse clinical outcomes and higher costs. Efforts to reduce complications in this population may lead to improved outcomes and cost savings.