Assessing relative cost of complications following orthotopic liver transplant
Assessing relative cost of complications following orthotopic liver transplant
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DOI：
10.1111/ctr.13209
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发表时间：
2018-04-01
影响因子：
2.1
通讯作者：
Martin, Robert C. G., II
中科院分区：
文献类型：
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作者：
Bhutiani, Neal;Jones, Christopher M.;Martin, Robert C. G., II
简介：围手术期并发症给患者和医疗保健系统带来临床和经济负担。本研究旨在确定原位肝移植 (OLT) 后并发症的发生频率和经济影响。方法：查询 Premier Perspective (R) 医院数据库，查找 2008 年至 2015 年间接受 OLT 的患者。并发症通过 ICD-9 代码进行识别，并按并发症类型进行分组。计算并发症发生率以及对临床和经济结果的影响。合并并发症发生频率和对费用的影响，以确定每种并发症类型对围手术期 OLT 费用的年度影响。结果：在 2747 名 OLT 患者中，OLT 后最常见的并发症包括肺部、出血和感染。对治疗相关费用平均影响最大的并发症是感染性、神经性、深静脉血栓形成/肺栓塞和肝动脉血栓形成。感染性、肺部和出血并发症对围手术期 OLT 费用的影响最大。结论：集中精力预防凝血病性出血、改善术后肺部排便和尽量减少感染源有助于提高 OLT 的成本效益。此外，这些成本数据和系统化协议的结合可以帮助保险公司构建 OLT 捆绑支付，更准确地反映围手术期移植护理的成本。
Introduction: Perioperative complications impose both a clinical and financial burden on patients and the healthcare system. This study sought to identify the frequency and economic impact of complications following orthotopic liver transplantation (OLT).Methods: The Premier Perspective (R) Hospital Database was queried for patients undergoing OLT between 2008 and 2015. Complications were identified by ICD-9 code and grouped by complication type. Complication frequency as well as impact on clinical and economic outcomes was calculated. Complication frequency and effect on cost were combined to determine the annual impact of each complication type on perioperative OLT cost.Results: Among 2747 OLT patients, the most common groups of complications following OLT were pulmonary, bleeding, and infectious. The complications with the greatest average effect on treatment-related costs were infectious, neurologic, deep vein thrombosis/pulmonary embolus, and hepatic arterial thrombosis. Infectious, pulmonary, and bleeding complications had the greatest annual effect on perioperative OLT cost.Conclusions: Efforts focused on preventing coagulopathic bleeding, improving postoperative pulmonary toilet, and minimizing sources of infection can help improve the cost-effectiveness of OLT. Additionally, the combination of these cost data and systematized protocols can help insurers construct bundled payments for OLT that more accurately reflect the cost of perioperative transplant care.