The cost of pneumonia after acute stroke
The cost of pneumonia after acute stroke
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DOI：
10.1212/01.wnl.0000263187.08969.45
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发表时间：
2007-05-29
期刊：
影响因子：
9.9
通讯作者：
Cebul, R. D.
中科院分区：
文献类型：
--
作者：
Katzan, I. L.;Dawson, N. V.;Cebul, R. D.
目的：确定脑卒中住院期间发生肺炎的增量成本。研究方法：我们回顾了1991年至1997年在一个大都市地区的29家医院因缺血性或出血性中风而入院的所有医疗保险患者的医院记录，不包括那些在入院后3天内死亡或未开具复苏医嘱的患者。中风患者的住院费用是在调整了影响费用和肺炎倾向的基线因素后，使用医疗保险提供者分析和审查数据确定的。次要分析检查了肺炎与出院处置的风险调整关系。结果如下：5.6%（635/11，286）的卒中患者发生肺炎，在疗养院和病情严重的患者中更常见（p < 0.001）。卒中伴肺炎患者的平均调整后住院费用为21，043美元（95% CI 19，698 - 22，387美元），无肺炎患者为6，206美元（95% CI 6，150 - 6，262美元），导致增加费用14，836美元（95% CI 14，436 - 15，236美元）。肺炎患者出院时需要延长护理的可能性超过70%（调整后OR 1.73，95% CI 1.32 - 2.26）。结论：外推到美国超过500，000名因中风住院的类似患者，作为急性中风后并发症的肺炎的年成本约为4.59亿美元。
Objective: To determine the incremental costs of pneumonia occurring during hospitalization for stroke. Methods: We reviewed hospital records of all Medicare patients admitted for ischemic or hemorrhagic stroke to 29 hospitals in a large metropolitan area, 1991 through 1997, excluding those who died or had do not resuscitate orders written within 3 days of admission. Hospital costs of patients with stroke were determined using Medicare Provider Analysis and Review data after adjustment for baseline factors affecting cost and propensity for pneumonia. Secondary analyses examined the risk-adjusted relationship of pneumonia to discharge disposition. Results: Pneumonia occurred in 5.6% (635/11,286) of patients with stroke, and was more common among patients admitted from nursing homes and those with greater severity of illness (p < 0.001). Mean adjusted costs of hospitalization for patients with stroke with pneumonia were $21,043 (95% CI $19,698 to 22,387) and were $6,206 (95% CI $ 6,150 to 6,262) for patients without pneumonia, resulting in an incremental cost of $ 14,836 ( 95% CI $ 14,436 to 15,236). Patients with pneumonia were over 70% more likely to be discharged with requirements for extended care (adjusted OR 1.73, 95% CI 1.32 to 2.26). Conclusion: Extrapolated to the over 500,000 similar patients hospitalized for stroke in the United States, the annual cost of pneumonia as a complication after acute stroke is approximately $ 459 million.