Fuchs Hans F, Broderick Ryan C, Harnsberger Cristina R, Chang David C, Mclemore Elisabeth C, Ramamoorthy Sonia, Horgan Santiago
Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
Department of General Surgery, University of Cologne, Cologne, Germany.
Surg Endosc. 2015 Nov;29(11):3090-6. doi: 10.1007/s00464-014-4046-0. Epub 2014 Dec 25.
Outcomes after surgery for diverticulitis are of continued interest to improve quality of care. The aim of this study was to assess variations in mortality, length of stay, and patient charges between geographic regions of the United States.
A retrospective analysis of the Nationwide Inpatient Sample database was performed. Adults with diverticulitis who underwent laparoscopic or open segmental colectomy were identified using ICD-9 codes. Subset analyses were performed by state and then compared. Outcomes included mortality, length of stay (LOS), and total charges. Results were adjusted for age, race, gender, findings of peritonitis, stoma placement, Charlson comorbidity index, and insurance status on multivariate analysis.
148,874 patients underwent segmental colectomy for diverticulitis from 1998 to 2010. Using California as the comparison state and after adjusting for covariates, in-hospital mortality was significantly higher in the State of New York (OR 1.32; 95 % CI 1.13-1.55; P < 0.05) and Mississippi (OR 2.84; 95 % CI 1.24-6.51, P < 0.02). Wisconsin had a significant lower mortality rate (OR 0.74; 95 % CI 0.59-0.94, P < 0.01). LOS was 1.4 days longer in New York and 0.54 days shorter in Wisconsin than in California (P < 0.01). Patients with age >40 years, findings of peritonitis, and without private insurance had higher in-hospital mortality and longer length of stay. Average hospital charges differed dramatically between the states in the observation period. The highest hospital charges occurred in California, Nebraska, and Nevada while lowest occurred in Maryland, Wisconsin and Utah.
Patients who undergo surgical treatment for diverticulitis in the United States have high geographic variation in mortality, LOS, and hospital charges despite adjusting for demographic and socioeconomic factors. Further analysis should be performed to identify the causes of outlier regions, with the goal of improving and standardizing best practices.
憩室炎手术后的治疗结果一直是人们关注的焦点，以提高医疗质量。本研究的目的是评估美国不同地理区域之间在死亡率、住院时间和患者费用方面的差异。
对全国住院患者样本数据库进行回顾性分析。使用ICD - 9编码识别接受腹腔镜或开放节段性结肠切除术的憩室炎成年患者。按州进行亚组分析，然后进行比较。结果包括死亡率、住院时间（LOS）和总费用。多因素分析结果根据年龄、种族、性别、腹膜炎表现、造口位置、查尔森合并症指数和保险状况进行了调整。
1998年至2010年期间，148,874例患者因憩室炎接受了节段性结肠切除术。以加利福尼亚州作为对照州并对协变量进行调整后，纽约州（OR 1.32；95% CI 1.13 - 1.55；P < 0.05）和密西西比州（OR 2.84；95% CI 1.24 - 6.51，P < 0.02）的住院死亡率显著更高。威斯康星州的死亡率显著更低（OR 0.74；95% CI 0.59 - 0.94，P < 0.01）。纽约州的住院时间比加利福尼亚州长1.4天，威斯康星州比加利福尼亚州短0.54天（P < 0.01）。年龄>40岁、有腹膜炎表现且没有私人保险的患者住院死亡率更高，住院时间更长。观察期内各州的平均住院费用差异很大。住院费用最高的是加利福尼亚州、内布拉斯加州和内华达州，而最低的是马里兰州、威斯康星州和犹他州。
在美国，尽管对人口统计学和社会经济因素进行了调整，但因憩室炎接受手术治疗的患者在死亡率、住院时间和住院费用方面仍存在很大的地理差异。应进行进一步分析以确定异常区域的原因，目标是改进和规范最佳实践。
