手术并发症所消耗的医院资源：术前补充精氨酸和ω-3脂肪酸对成本的影响。

Hospital resources consumed for surgical morbidity: effects of preoperative arginine and omega-3 fatty acid supplementation on costs.

作者信息

Braga Marco, Gianotti Luca, Vignali Andrea, Schmid Alexandra, Nespoli Luca, Di Carlo Valerio

机构信息

Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy.

出版信息

Nutrition. 2005 Nov-Dec;21(11-12):1078-86. doi: 10.1016/j.nut.2005.05.003.

DOI:10.1016/j.nut.2005.05.003

PMID:16308130

Abstract

OBJECTIVE

Costs related to postoperative complications continue to be a major burden on any health care system. The aim of the present study was to calculate hospital costs for postoperative complications and to evaluate whether preoperative supplementation with omega-3 fatty acids and arginine (specialized diet) might lead to cost savings in patient care.

METHODS

Blind analysis of costs performed on data gathered from a randomized clinical trial carried out on 305 patients with gastrointestinal cancer showed that an oral preoperative specialized diet decreased postoperative morbidity compared with conventional treatment (no supplementation). Estimates of complication costs were based on resources used for treatment and on additional length of hospital stay. Cost-comparison and cost-effectiveness analyses were then carried out.

RESULTS

The mean cost of postoperative complications was 4492 pounds sterlings. The greatest amount of resources was consumed by 19 anastomotic leaks (159,803 pounds sterlings), 18 abdominal abscesses (112,921 pounds sterlings), and 18 pancreatic fistulae (106,516 pounds sterlings). The mean costs per complication were 6178 pounds sterlings in the conventional group and 4639 pounds sterlings in the preoperative group (P = 0.05). The mean total costs of patients with complications were 10,494 pounds sterlings in the conventional group and 8793 pounds sterlings in the preoperative group. The mean cost per randomized patient was 3122 pounds sterlings in the conventional group versus 1872 pounds sterlings in the preoperative group (P = 0.04). Effectiveness values were 50.0% in the conventional group and 62.8% in the preoperative group (P = 0.03). Total costs consumed 93% of the diagnosis-related group reimbursement rate in the conventional group and 78% in the preoperative group.

CONCLUSIONS

The costs of postoperative morbidity consumed a large amount of the diagnosis-related group reimbursement rate. Preoperative supplementation with the specialized diet appears to be a cost-effective treatment.

摘要

目的

术后并发症相关费用仍然是任何医疗保健系统的主要负担。本研究的目的是计算术后并发症的医院费用，并评估术前补充ω-3脂肪酸和精氨酸（特殊饮食）是否可能在患者护理方面节省成本。

方法

对305例胃肠道癌患者进行的一项随机临床试验收集的数据进行成本的盲法分析，结果显示与传统治疗（不补充）相比，术前口服特殊饮食可降低术后发病率。并发症成本的估计基于治疗所用资源和额外住院时间。然后进行成本比较和成本效益分析。

结果

术后并发症的平均成本为4492英镑。19例吻合口漏（159,803英镑）、18例腹腔脓肿（112,921英镑）和18例胰瘘（106,516英镑）消耗的资源最多。传统组每种并发症的平均成本为6178英镑，术前组为4639英镑（P = 0.05）。并发症患者的平均总成本在传统组为10,494英镑，术前组为8793英镑。传统组每名随机分组患者的平均成本为3122英镑，术前组为1872英镑（P = 0.04）。传统组的有效性值为50.0%，术前组为62.8%（P = 0.03）。传统组的总成本消耗了诊断相关组报销率的93%，术前组为78%。