Health Economics, GE Healthcare, Waukesha, WI, USA.
J Med Econ. 2012;15(1):1-7. doi: 10.3111/13696998.2011.628723. Epub 2011 Oct 19.
Abdominal paracentesis is commonly performed for diagnostic, therapeutic, and palliative indications, but the use of ultrasound guidance for these procedures is relatively recent, variable, and not well documented. A retrospective database analysis of abdominal paracentesis procedures was performed to determine whether ultrasound guidance was associated with differences in adverse events (AEs) or hospital costs, compared to procedures without ultrasound guidance.
The hospital database maintained by Premier was used to identify patients with abdominal paracentesis International Classification of Diseases - 9th Revision - Clinical Modification (ICD-9 code 54.9, Common Procedural Terminology CPT-4 codes 49080, 49081) in 2008. Use of ultrasound guidance was determined via patient billing data. The incidence of selected AEs and patients' hospitalization costs were calculated for two groups: procedures with ultrasound guidance and those without. Univariate and multivariable analyses were performed to evaluate differences between groups.
This study identified 1297 abdominal paracentesis procedures, 723 (56%) with ultrasound and 574 (44%) without. The indications for paracentesis were similar between the two groups. The incidence of AEs was lower in ultrasound-guided procedures: all AEs (1.4% vs 4.7%, p = 0.01), post-paracentesis infection (0.41% vs 2.44%, p = 0.01), hematoma (0.0% vs 0.87%, p = 0.01), and seroma (0.14% vs 1.05%, p = 0.03). Analyses adjusted for patient and hospital covariates revealed significant reductions in AEs (OR = 0.349, 95% CI = 0.165, 0.739, p = 0.0059) and hospitalization costs ($8761 ± $5956 vs $9848 ± $6581, p < 0.001) for procedures with ultrasound guidance vs those without.
There are several limitations to using claims data for clinical analyses; causality cannot be determined, the possibility of miscoded or missing data, and the inability to control for elements not captured in claims data that may influence clinical outcomes.
The use of ultrasound guidance in abdominal paracentesis procedures is associated with fewer AEs and lower hospitalization costs than procedures where ultrasound is not used.
腹腔穿刺术常用于诊断、治疗和姑息治疗，但超声引导在这些操作中的应用相对较新、多变且记录不佳。对腹腔穿刺术的回顾性数据库分析旨在确定与无超声引导相比，超声引导是否与不良事件（AE）或住院费用的差异相关。
使用 Premier 维护的医院数据库确定 2008 年患有腹腔穿刺术的患者（国际疾病分类第 9 修订版临床修正 ICD-9 代码 54.9，常见程序术语 CPT-4 代码 49080、49081）。通过患者计费数据确定是否使用超声引导。计算两组患者的选定 AE 发生率和住院费用：有超声引导的组和无超声引导的组。进行单变量和多变量分析以评估组间差异。
本研究确定了 1297 例腹腔穿刺术，其中 723 例（56%）有超声引导，574 例（44%）无超声引导。两组穿刺术的适应证相似。超声引导组 AE 发生率较低：所有 AE（1.4% vs 4.7%，p=0.01）、穿刺后感染（0.41% vs 2.44%，p=0.01）、血肿（0.0% vs 0.87%，p=0.01）和血清肿（0.14% vs 1.05%，p=0.03）。调整患者和医院协变量后，分析显示超声引导组 AE（OR=0.349，95%CI=0.165，0.739，p=0.0059）和住院费用（$8761±$5956 vs $9848±$6581，p<0.001）显著降低。
使用索赔数据进行临床分析有几个限制；无法确定因果关系，存在代码错误或数据缺失的可能性，以及无法控制索赔数据中未捕获的可能影响临床结果的因素。
与未使用超声的手术相比，超声引导在腹腔穿刺术中与更少的 AE 和更低的住院费用相关。
Zotero 插件