Parker Scott L, McGirt Matthew J, Murphy Jeffrey A, Megerian J Thomas, Stout Michael, Engelhart Luella
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
DePuy Orthopaedics, Warsaw, Indiana, USA.
World Neurosurg. 2015 Mar;83(3):382-6. doi: 10.1016/j.wneu.2014.06.010. Epub 2014 Jun 13.
Cerebrospinal fluid (CSF) shunt infection is a major cause of morbidity and mortality in the treatment of hydrocephalus and is associated with significant medical cost. Several studies have demonstrated the efficacy of antibiotic-impregnated (AI) shunt catheters in reducing CSF shunt infection; however, providers remain reluctant to adopt AI catheters into practice because of the increased upfront cost. The objective of this study was to determine if the use of AI catheters provided cost savings in a large nationwide database.
Hospital discharge and billing records from the Premier Perspective Database from 2003-2009 were retrospectively reviewed to identify all adult and pediatric patients undergoing de novo ventricular shunt placement. The incidence of shunt infection within 1 year of implantation was determined. Shunt infection-related cost was defined as all inpatient billing costs incurred during hospitalization for treatment of shunt infection.
In 287 U.S. hospitals, 10,819 adult (AI catheters, 963; standard catheters, 9856) and 1770 pediatric (AI catheters, 229; standard catheters, 1541) patients underwent ventricular shunt placement. AI catheters were associated with significant reduction in infection for both adult (2.2% vs. 3.6%, P = 0.02) and pediatric (2.6% vs. 7.1%, P < 0.01) patients. Total infection-related costs were $17,371,320 ($45,714 ± $49,745 per shunt infection) for adult patients and $6,508,064 ($56,104 ± $65,746 per shunt infection) for pediatric patients. Infection-related cost per 100 de novo shunts placed was $120,534 for AI catheters and $162,659 for standard catheters in adult patients and $165,087 for AI catheters and $395,477 for standard catheters in pediatric patients.
In analysis of this large, nationwide database, AI catheters were found to be associated with a significant reduction in infection incidence, resulting in tremendous cost savings. AI catheters were associated with a cost savings of $42,125 and $230,390 per 100 de novo shunts placed in adult and pediatric patients, respectively.
脑脊液（CSF）分流感染是脑积水治疗中发病和死亡的主要原因，且与高昂的医疗费用相关。多项研究已证明抗生素浸渍（AI）分流导管在降低脑脊液分流感染方面的有效性；然而，由于前期成本增加，医疗服务提供者仍不愿在实践中采用AI导管。本研究的目的是在一个大型全国性数据库中确定使用AI导管是否能节省成本。
回顾性分析2003 - 2009年Premier Perspective数据库中的医院出院和计费记录，以识别所有接受初次脑室分流置管的成年和儿科患者。确定植入后1年内分流感染的发生率。分流感染相关成本定义为住院期间因治疗分流感染而产生的所有住院计费成本。
在美国287家医院，10819名成年患者（AI导管组963例，标准导管组9856例）和1770名儿科患者（AI导管组229例，标准导管组1541例）接受了脑室分流置管。AI导管在成年患者（2.2%对3.6%，P = 0.02）和儿科患者（2.6%对7.1%，P < 0.01）中均与感染显著减少相关。成年患者的总感染相关成本为17371320美元（每次分流感染45714 ± 49745美元），儿科患者为6508064美元（每次分流感染56104 ± 65746美元）。成年患者中，每100例初次分流置管的AI导管感染相关成本为120534美元，标准导管为162659美元；儿科患者中，AI导管为165087美元，标准导管为395477美元。
在对这个大型全国性数据库的分析中，发现AI导管与感染发生率显著降低相关，从而节省了大量成本。每100例成年和儿科患者的初次分流置管，AI导管分别节省成本42125美元和230390美元。
