Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, BOX SURG, Rochester, NY 14642, USA.
Surg Endosc. 2010 Jun;24(6):1250-5. doi: 10.1007/s00464-009-0755-1. Epub 2009 Dec 24.
Large-scale, population-based analyses of the demographics, management, and healthcare resource utilization of patients with an intrathoracic stomach are largely unknown, an issue which has become more important with the aging of the population. Our objective was to understand the magnitude of the problem and to assess clinical outcomes and hospital costs in elective and emergent admissions of patients with an intrathoracic stomach in a large population-based study.
The New York Statewide Planning and Research Cooperative System (SPARCS) administrative database was queried for primary ICD-9-CM codes 553.3 and 552.3 in patients 18 years or older; 4858 hospital admissions were identified over a 5-year period (2002-2006). Database variables included age, gender, race, type of admission, operative intervention, in-hospital mortality, length of stay, and cost.
Approximately 1000 patients are admitted to the hospital each year with primary diagnosis of intrathoracic stomach, an estimated 52 per 1 million of the population in New York State. Over half of those (53%) were emergent admissions. Interestingly, the majority of emergent admissions (66%) were discharged before any surgical intervention. Patients admitted emergently were older (68.0 vs. 62.1 years, p < 0.0001) and more likely African-American (12% vs. 6%, p < 0.0001). Compared to elective admissions, emergent admissions had higher mortality (2.7% vs. 1.2%, p < 0.001), longer length of stay (LOS) (7.3 vs. 4.9 days, p < 0.0001), and higher cost ($28,484 vs. $24,069, p < 0.001). Among patients who underwent surgery, emergent admissions had higher mortality (5.1% vs. 1.1%, p < 0.0001), greater LOS (13.1 vs. 4.9 days, p < 0.0001), and higher costs ($55,460 vs. $24,760, p < 0.0001). Multivariate regression analysis demonstrated age, emergent presentation, and operative admission as independent predictors for hospital mortality, LOS, and cost (p < 0.0001).
Strikingly, more than half of admissions for intrathoracic stomach were emergent. Emergent admissions had higher mortality, longer LOS, and higher cost than elective admissions. These data support consideration of early elective repair.
对于胸腔内胃患者的人口统计学、治疗管理和医疗资源利用情况，目前尚缺乏大规模的基于人群的分析，而随着人口老龄化，这一问题变得更加重要。我们的目的是了解这一问题的严重程度，并在一项大型基于人群的研究中评估择期和紧急入院的胸腔内胃患者的临床结局和住院费用。
我们查询了纽约州全州规划和研究合作系统（SPARCS）的 ICD-9-CM 主要代码 553.3 和 552.3，纳入年龄在 18 岁或以上的患者；在 5 年期间（2002-2006 年），共确定了 4858 例住院患者。数据库变量包括年龄、性别、种族、入院类型、手术干预、院内死亡率、住院时间和费用。
每年约有 1000 名患者因胸腔内胃的主要诊断而入院，纽约州每 100 万人中有 52 人。其中超过一半（53%）为紧急入院。有趣的是，大多数紧急入院（66%）在接受任何手术干预之前就已出院。紧急入院的患者年龄更大（68.0 岁 vs. 62.1 岁，p<0.0001），更可能是非洲裔美国人（12% vs. 6%，p<0.0001）。与择期入院相比，紧急入院的死亡率更高（2.7% vs. 1.2%，p<0.001），住院时间（LOS）更长（7.3 天 vs. 4.9 天，p<0.0001），费用更高（28484 美元 vs. 24069 美元，p<0.001）。在接受手术的患者中，紧急入院的死亡率更高（5.1% vs. 1.1%，p<0.0001），住院时间更长（13.1 天 vs. 4.9 天，p<0.0001），费用更高（55460 美元 vs. 24760 美元，p<0.0001）。多变量回归分析表明，年龄、紧急就诊和手术入院是院内死亡率、LOS 和费用的独立预测因素（p<0.0001）。
令人惊讶的是，超过一半的胸腔内胃入院为紧急入院。紧急入院的死亡率、LOS 和费用均高于择期入院。这些数据支持考虑早期择期修复。
