Dinan Michaela A, Chou Chia-Hung, Hammill Bradley G, Graham Felicia L, Schulman Kevin A, Telen Marilyn J, Reed Shelby D
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Am J Hematol. 2009 Nov;84(11):703-9. doi: 10.1002/ajh.21520.
In this study, we examined differences in inpatient costs, length of stay, and in-hospital mortality between hospitalizations for patients with and without sickle cell disease (SCD) undergoing high-volume surgical procedures. We used Clinical Classification Software (CCS) codes to identify discharges in the 2002-2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for patients who had undergone either cholecystectomy or hip replacement. We limited the non-SCD cohort to hospitals where patients with SCD had undergone the same procedure. We compared inpatient outcomes using summary statistics and generalized linear regression analysis to adjust for patient, hospital, and procedural characteristics. Overall, the median age of surgical patients with SCD was more than three decades less than the median age of patients without SCD undergoing the same procedure. In recognition of the age disparity, we limited the analyses to patients aged 18 to 64 years. Nonetheless, patients with SCD undergoing cholecystectomy or hip replacement were 12.1 and 14.4 years younger, had inpatient stays that were 73% and 82% longer, and incurred costs that were 46% and 40% higher per discharge than patients without SCD, respectively. Inpatient mortality for these procedures was low, approximately 0.6% for cholecystectomy and 0.2% for hip replacement and did not differ significantly between patients with and without SCD. Multivariable regression analyses revealed that higher inpatient costs among patients with SCD were primarily attributable to longer hospital stays. Patients with SCD who underwent cholecystectomy or hip replacement required more health care resources than patients without SCD. Am. J. Hematol. 2009. (c) 2009 Wiley-Liss, Inc.
在本研究中，我们调查了接受高容量外科手术的镰状细胞病（SCD）患者与非SCD患者住院费用、住院时间和院内死亡率的差异。我们使用临床分类软件（CCS）编码，在2002 - 2005年医疗成本和利用项目全国住院患者样本中识别接受胆囊切除术或髋关节置换术的患者出院情况。我们将非SCD队列限制在SCD患者接受过相同手术的医院。我们使用汇总统计和广义线性回归分析来比较住院结局，以调整患者、医院和手术特征。总体而言，接受相同手术的SCD外科患者的年龄中位数比非SCD患者的年龄中位数少三十多年。鉴于年龄差异，我们将分析限制在18至64岁的患者。尽管如此，接受胆囊切除术或髋关节置换术的SCD患者分别比非SCD患者年轻12.1岁和14.4岁，住院时间长73%和82%，每次出院费用高46%和40%。这些手术的住院死亡率较低，胆囊切除术约为0.6%，髋关节置换术约为0.2%，SCD患者与非SCD患者之间无显著差异。多变量回归分析显示，SCD患者住院费用较高主要归因于住院时间较长。接受胆囊切除术或髋关节置换术的SCD患者比非SCD患者需要更多的医疗资源。《美国血液学杂志》2009年。（c）2009威利 - 利斯公司。
