择期神经介入手术后转入降阶治疗单元的安全性和成本效益。
Safety and cost effectiveness of step-down unit admission following elective neurointerventional procedures.
机构信息
Department of Surgery, Division of Neurosurgery, University of Alabama, Birmingham, Alabama, USA.
出版信息
J Neurointerv Surg. 2012 Sep;4(5):390-2. doi: 10.1136/neurintsurg-2011-010058. Epub 2011 Aug 5.
OBJECTIVE
Post-procedure monitoring in a neurointensive care unit (NICU) after neurointerventional procedures is conventional at most centers. However, NICU resources are scarce and costly. The purpose of this study was to determine whether an intermediate care step-down unit could be a safe and cost-effective alternative to the NICU for patients after uncomplicated neurointerventional procedures.
METHODS
A retrospective review was undertaken of 127 consecutive patients over a 3-year period undergoing elective neurointerventional procedures including treatment of intracranial aneurysms, tumors, arteriovenous malformations and dural arteriovenous fistulas. Seventy-one patients were admitted to a step-down unit and 56 patients were admitted to the NICU. Endpoints were post-procedural complications, hospital costs and length of stay. Patients admitted to the step-down unit were compared with patients admitted to the NICU.
RESULTS
Patients admitted to the step-down unit did not have more complications than patients admitted to the NICU. Two patients admitted to the step-down unit had neurological complications after the procedure which were immediately recognized by nursing staff and adequately managed. The mean (SD) total cost per patient was $19,299 ($6955) for patients admitted to the step-down unit and $22,716 ($8052) for patients admitted to the NICU, resulting in a statistically significant cost saving for patients admitted to the step-down unit of $3417 (p=0.012). The mean (SD) total cost less procedural costs per patient was $8442 ($4062) for patients in the step-down unit and $10,631 ($4727) for those admitted to the NICU, which was also statistically significant (p=0.005). Length of stay averaged 21.7 h for patients admitted to the step-down unit and 24.9 h for those admitted to the NICU (p=0.016).
CONCLUSIONS
A step-down unit is a safe and cost-effective alternative to the NICU for patients undergoing elective neurointerventional procedures.
目的
在大多数中心，神经介入手术后在神经重症监护病房（NICU）进行术后监测是常规操作。然而，NICU 资源稀缺且昂贵。本研究旨在确定对于接受简单神经介入治疗的患者，中间护理下病房是否可以作为 NICU 的安全且具有成本效益的替代方案。
方法
对 3 年内 127 例连续接受择期神经介入治疗的患者（包括颅内动脉瘤、肿瘤、动静脉畸形和硬脑膜动静脉瘘的治疗）进行回顾性研究。71 例患者入住下病房，56 例患者入住 NICU。研究终点为术后并发症、住院费用和住院时间。比较入住下病房的患者和入住 NICU 的患者。
结果
入住下病房的患者并发症发生率并不高于入住 NICU 的患者。2 例入住下病房的患者术后出现神经系统并发症，被护理人员立即识别并妥善处理。入住下病房的患者平均（标准差）每位患者的总费用为 19299 美元（6955 美元），入住 NICU 的患者为 22716 美元（8052 美元），入住下病房的患者节省费用 3417 美元，差异具有统计学意义（p=0.012）。入住下病房的患者平均（标准差）每位患者的总费用减去治疗费用为 8442 美元（4062 美元），入住 NICU 的患者为 10631 美元（4727 美元），差异具有统计学意义（p=0.005）。入住下病房的患者平均住院时间为 21.7 小时，入住 NICU 的患者为 24.9 小时，差异具有统计学意义（p=0.016）。
结论
对于接受择期神经介入治疗的患者，下病房是 NICU 的安全且具有成本效益的替代方案。
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