Malone M, Lau N S, White J, Novak A, Xuan W, Iliopoulos J, Crozier J, Dickson H G
High Risk Foot Service, Liverpool Hospital, Liverpool, NSW 2170, Australia; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.
LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia.
Eur J Vasc Endovasc Surg. 2014 Oct;48(4):447-51. doi: 10.1016/j.ejvs.2014.07.001. Epub 2014 Aug 10.
To determine the impact of diabetes mellitus (DM) and other comorbidities on length of stay (LOS) and costs in patients with peripheral arterial disease (PAD) admitted to a vascular surgical unit.
A retrospective study was conducted between January 2011 and July 2012 at a tertiary referral hospital in Sydney. Demographic, laboratory, and operative data were obtained from the Australasian Vascular Audit database and hospital diagnostic-related group (DRG) reports. Patients with confirmed PAD with or without DM requiring hospital admission for a diagnosis of claudication, rest pain, ulcer/gangrene, and infection that required lower limb surgical intervention were included. Associations between LOS, surgical procedure, and DRG were explored.
Five hundred and sixty-eight admissions (492 patients) were identified: 292 admissions with PAD and 276 admissions with PAD in conjunction with DM (PADDM). Mean LOS for patients with PAD was 10 ± 13.7 days compared with 15 ± 18.2 days for PADDM (p < .01; 95% confidence interval 2.7-8.0). LOS and costs were greatest in patients with PADDM undergoing major amputation (37 ± 13.7 days; US$42,236; p < .01). Analysis of variance indicated that the best predictors of LOS were the presence of DM, bypass surgery, amputation, chronic kidney disease (CKD) stage V, infection, and emergency admission. Over 18 months, the estimated total inpatient costs associated with lower limb intervention for PAD with and without DM amounted to US$7,598,597. People with DM incurred greater inpatient costs, averaging US$1,912 more per episode of admission and a total of US$528,029 over 18 months.
The impact of diabetes as a comorbid condition in patients with PAD is significant, both clinically and economically. Factors that predict increased LOS in patients with PAD are DM, bypass surgery, amputation, CKD stage V, infection, and emergency admission.
确定糖尿病（DM）及其他合并症对血管外科收治的外周动脉疾病（PAD）患者住院时间（LOS）和费用的影响。
于2011年1月至2012年7月在悉尼一家三级转诊医院开展一项回顾性研究。人口统计学、实验室及手术数据取自澳大利亚血管审计数据库和医院诊断相关组（DRG）报告。纳入确诊为PAD且伴有或不伴有DM、因间歇性跛行、静息痛、溃疡/坏疽及感染需要住院以接受下肢手术干预的患者。探讨了住院时间、手术方式和DRG之间的关联。
共确定了568例入院病例（492例患者）：292例PAD入院病例和276例PAD合并DM（PADDM）入院病例。PAD患者的平均住院时间为10±13.7天，而PADDM患者为15±18.2天（p<0.01；95%置信区间2.7-8.0）。接受大截肢手术的PADDM患者的住院时间和费用最高（37±13.7天；42,236美元；p<0.01）。方差分析表明，住院时间的最佳预测因素为DM、搭桥手术、截肢、慢性肾脏病（CKD）Ⅴ期、感染和急诊入院。在18个月内，伴有和不伴有DM的PAD下肢干预相关的估计住院总费用达7,598,597美元。患有DM的患者住院费用更高，每次入院平均多支出1,912美元，18个月内总计多支出528,029美元。
DM作为PAD患者的合并症，在临床和经济方面的影响均很显著。预测PAD患者住院时间延长的因素为DM、搭桥手术、截肢、CKDⅤ期、感染和急诊入院。
