Sawant Abhishek, Mills Paul K, Dhingra Hemant
Department of Internal Medicine, Community Regional Medical Center, University of California, San Francisco, Fresno Medical Education Program, Fresno, California 93720, USA.
Semin Dial. 2013 Jan-Feb;26(1):106-10. doi: 10.1111/j.1525-139X.2012.01083.x. Epub 2012 Jun 11.
The creation and maintenance of vascular access for hemodialysis patients is responsible for a significant amount of morbidity and hospital expenses which continue to escalate with increasing population of ESRD patients. A retrospective review of patient charts were performed from 2008 to May 2011 at an academic tertiary care center who had a diagnosis of vascular access failure based on ICD 9 coding. Data regarding demographic information, length of stay (LOS), source of insurance, hospital expenses, and discharge status were obtained. Based on strict inclusion criteria we identified 172 total patients. The mean age among all patients was 60.53 ± 15.35 years and the majority of patients were Hispanic (n = 81). The Mean LOS was 5.30 ± 4.64 days. Mean hospital costs were 41,896 ± 20,318 US$. Patients admitted for tunneled dialysis placement had greater length of stay (p-value = 0.011) as did patients with hypertension (p-value = 0.030). Hospital expenses were significantly higher for patients admitted for arterio-venous fistula complications (55,456 ± 23,779 US$) compared with admissions for catheter or dialysis graft related complications (p-value = 0.004). Patients on Medicare had significantly lower length of stay (3.98 ± 3.32 days) compared with patients with Medicare/Medical (6.59 ± 5.69 days), p-value = 0.047. Inpatient management of vascular access failure is associated with increased length of stay, and significant hospital expenses. Timely referral to vascular access centers can prevent unnecessary hospitalizations and provide cost-saving benefits.
为血液透析患者建立和维护血管通路会导致大量发病情况和医院费用，随着终末期肾病（ESRD）患者数量的增加，这些费用持续攀升。在一所学术性三级医疗中心，对2008年至2011年5月期间根据国际疾病分类第九版（ICD 9）编码诊断为血管通路失败的患者病历进行了回顾性研究。获取了有关人口统计学信息、住院时间（LOS）、保险来源、医院费用和出院状态的数据。根据严格的纳入标准，共确定了172名患者。所有患者的平均年龄为60.53±15.35岁，大多数患者为西班牙裔（n = 81）。平均住院时间为5.30±4.64天。平均医院费用为41,896±20,318美元。因隧道式透析置管入院的患者住院时间更长（p值 = 0.011），高血压患者也是如此（p值 = 0.030）。与因导管或透析移植物相关并发症入院的患者相比，因动静脉内瘘并发症入院的患者医院费用显著更高（55,456±23,779美元）（p值 = 0.004）。与有医疗保险/医疗补助的患者（6.59±5.69天）相比，参加医疗保险的患者住院时间显著更短（3.98±3.32天），p值 = 0.047。血管通路失败的住院管理与住院时间延长和高额医院费用相关。及时转诊至血管通路中心可预防不必要的住院并节省成本。
