Patwardhan Ravish V, Nanda Anil
Department of Neurosurgery, Louisiana State University Health Sciences Center at Shreveport, Shreveport, Louisiana 71105, USA.
Neurosurgery. 2005;56(1):139-44; discussion 144-5. doi: 10.1227/01.neu.0000146206.40375.41.
To characterize admissions related to ventricular shunts in the year 2000 in terms of diagnoses, procedures, socioeconomic status, and other related data.
The Nationwide Inpatient Sample database (year 2000) was analyzed retrospectively. We reviewed 7.45 million patient admissions for primary International Classification of Diseases, 9th Revision, procedure codes 023 to 0243 (ventricular shunts to peritoneal, atrial, pleural, and urinary systems for initial placement, revision, and removal); admissions listing ventriculostomy placement (code 022) were excluded from analysis.
Five thousand five hundred seventy-four admissions were identified. Admission sources primarily were routine (58.8%) and the emergency department (32.4%). Admission types primarily were elective (43.3%), emergent (33.2%), and urgent (21.9%). The top three primary diagnoses treated were shunt malfunction (40.7%), noncommunicating hydrocephalus (16.6%), and communicating hydrocephalus (13.2%). Shunt infection was the primary diagnosis in 7.2% of admissions. Age frequency of admissions was nonparametric, being highest for infants; the average stay was 8.4 +/- 0.2 days (standard error range, 0-243 d). The most common procedures were ventriculoperitoneal shunt placement (43.4%) and ventricular shunt replacement (42.8%); ventricular shunt removal occurred in 7.3% of admissions, whereas ventricle-to-thorax (0.6%), ventricle-to-circulatory system (0.5%), and ventricle-to-urinary system (0.05%) shunts were rare. Average cost was $35,816 +/- $810 (standard error range, $137-$814,748). Primary payers primarily were private insurers (43.8%), Medicare (26.0%), and Medicaid (24.5%). Disposition mainly was routine (78.4%, with home health care in 6.5%), and inpatient mortality was 2.7%. There was no socioeconomic disproportion in treatment with respect to average household income.
Ventricular shunts as primary procedures constitute a significant medical and economic problem.
根据诊断、手术、社会经济状况及其他相关数据，描述2000年与脑室分流术相关的住院情况。
对全国住院患者样本数据库（2000年）进行回顾性分析。我们审查了745万例患者的住院记录，其主要国际疾病分类第九版手术编码为023至0243（脑室分流至腹膜、心房、胸膜和泌尿系统进行初次置管、翻修和拔除）；将列出脑室造瘘术置管（编码022）的住院记录排除在分析之外。
共识别出5574例住院病例。住院来源主要为常规途径（58.8%）和急诊科（32.4%）。住院类型主要为择期（43.3%）、急诊（33.2%）和 urgent（21.9%）。接受治疗的前三位主要诊断为分流故障（40.7%）、非交通性脑积水（16.6%）和交通性脑积水（13.2%）。分流感染是7.2%的住院病例的主要诊断。住院年龄频率呈非参数分布，婴儿最高；平均住院时间为8.4±0.2天（标准误范围，0 - 243天）。最常见的手术是脑室腹腔分流术置管（43.4%）和脑室分流术翻修（42.8%）；7.3%的住院病例进行了脑室分流拔除，而脑室至胸腔（0.6%）、脑室至循环系统（0.5%）和脑室至泌尿系统（0.05%）分流术很少见。平均费用为35816±810美元（标准误范围，137 - 814748美元）。主要支付方主要是私人保险公司（43.8%）、医疗保险（26.0%）和医疗补助（24.5%）。出院处置主要为常规方式（78.4%，其中6.5%接受家庭医疗护理），住院死亡率为2.7%。在治疗方面，平均家庭收入不存在社会经济不均衡情况。
作为主要手术的脑室分流术构成了一个重大的医疗和经济问题。
