Straatman Jennifer, Cuesta Miguel A, de Lange-de Klerk Elly S M, van der Peet Donald L
Department of Gastrointestinal Surgery, VU Medical Centre Amsterdam, The Netherlands.
Dig Surg. 2015;32(2):150-6. doi: 10.1159/000371861. Epub 2015 Mar 18.
Complications after major abdominal surgery (MAS) are associated with increased morbidity and mortality. Rising costs in health care are of increasing interest and a major factor affecting hospital costs are postoperative complications. In this study, the costs associated with complications are assessed.
Retrospective cohort study of 399 consecutive patients that underwent MAS. Analysis of total costs for hospital stay, complications and treatment was performed, including bootstrapping; allowing for subtraction of data with 95% confidence intervals.
For a single patient who underwent MAS the average costs, adjusted for ASA-classification and surgery type, adds up to EUR 8,584.81 (95% CI EUR 8,332.51 - EUR 8,860.81) in patients without complications. EUR 15,412.96 (95% CI EUR 14,250.22 - EUR 16,708.82) after minor complications, and EUR 29,198.23 (95% CI EUR 27,187.13 - EUR 31,295.78) after major complications (p < 0.001).
The results provide an insight into the scope of hospital costs associated with complications. Major complications occur in 20% of patients undergoing MAS and account for 50% of the total costs of care. Implementation of a protocol aimed at early diagnosis and treatment of complications might lead to a decrease in morbidity and mortality, but also prove to be cost effective.
腹部大手术（MAS）后的并发症与发病率和死亡率的增加相关。医疗保健费用的不断上涨日益受到关注，影响医院成本的一个主要因素是术后并发症。在本研究中，对与并发症相关的成本进行了评估。
对399例连续接受MAS的患者进行回顾性队列研究。对住院总费用、并发症和治疗费用进行分析，包括自抽样法；允许减去具有95%置信区间的数据。
对于接受MAS的单个患者，在无并发症的患者中，根据美国麻醉医师协会（ASA）分级和手术类型调整后的平均费用总计为8584.81欧元（95%置信区间为8332.51欧元至8860.81欧元）。轻微并发症后为15412.96欧元（95%置信区间为14250.22欧元至16708.82欧元），严重并发症后为29198.23欧元（95%置信区间为27187.13欧元至31295.78欧元）（p<0.001）。
研究结果深入了解了与并发症相关的医院成本范围。20%接受MAS的患者发生严重并发症，占总护理成本的50%。实施旨在早期诊断和治疗并发症的方案可能会降低发病率和死亡率，而且还证明具有成本效益。
