Bir Shyamal C, Maiti Tanmoy Kumar, Ambekar Sudheer, Nanda Anil
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, USA.
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, USA.
Clin Neurol Neurosurg. 2015 Nov;138:99-103. doi: 10.1016/j.clineuro.2015.07.021. Epub 2015 Aug 17.
This study provides the first United States (US) national data regarding frequency, cost and mortality rate of epidural hematoma (EDH) and determines the factors affecting the morbidity and deaths in the patients with EDH undergoing surgical evacuation.
A retrospective analysis was performed by searching the Nationwide Inpatient Sample (NIS) from 2003 to 2010, the largest all payer database of non-federal community hospitals in the US. All cases of EDH were indentified using ICD-9 codes.
A total of 5189 admissions were identified in the NIS database, and incidence was highest in the second decade (33.4%). The median length of stay in the hospital was about 4 days in each year (2003-2010) without significant difference. The percent of discharge disposition other than home was about 2-3% in the entire cohort, with the highest in 2009 (3%). The average cost per admission increased significantly (80%) from $45,850 in 2003 to $82,800 in 2010. The inhospital mortality and complication rate was 3.5% and 2.9%, respectively. Factors affecting in-hospital mortality rate were age (≤18 yr vs. >18 yr, P<0.001), insurance type (medicare vs. private insurance, P<0.001), co-morbidities (high vs. low, P<0.001), hospital volume (high vs. low volume, P<0.001), physician's case volumes (high vs. low volume, P<0.02), hospital type (teaching vs. non-teaching, P<0.01) and hospital region (South vs. others, P<0.02). Similarly, factors affecting adverse outcome at discharge were age (≤18 yr vs. >18 yr, P<0.001), female gender (P<0.001), median income (fourth quartile vs. other, P<0.001), ethnicity (African-American vs. non-African-American, P<0.02), insurance type (medicare vs. private insurance, P<0.001), co-morbidities (high vs. low, P<0.001), hospital case volume (4th quartile volume vs. other, P<0.001), physician's case volume (4th quartile volume vs. other, P<0.0001), hospital type (teaching vs. non-teaching, hospital bed size (small vs. large, P<0.001), hospital region (Northeast vs. others, P<0.001) and hospital location (urban vs. rural, P<0.001).
Nationally, there has been no significant change in the frequency of EDH. However, its cost is increasing rapidly.
本研究提供了美国首个关于硬膜外血肿（EDH）的发病率、成本及死亡率的全国性数据，并确定了影响接受手术清除血肿的EDH患者发病和死亡的因素。
通过检索2003年至2010年的全国住院患者样本（NIS）进行回顾性分析，NIS是美国最大的非联邦社区医院的全支付方数据库。使用ICD - 9编码识别所有EDH病例。
在NIS数据库中总共识别出5189例入院病例，发病率在第二个十年最高（33.4%）。每年（2003 - 2010年）的中位住院时间约为4天，无显著差异。在整个队列中，非回家出院处置的比例约为2% - 3%，2009年最高（3%）。每次入院的平均成本从2003年的45,850美元显著增加（80%）至2010年的82,800美元。住院死亡率和并发症发生率分别为3.5%和2.9%。影响住院死亡率的因素有年龄（≤18岁与>18岁，P<0.001）、保险类型（医疗保险与私人保险，P<0.001）、合并症（高与低，P<0.001）、医院规模（大与小，P<0.001）、医生病例量（高与低，P<0.02）、医院类型（教学医院与非教学医院，P<0.01）和医院所在地区（南部与其他地区，P<0.02）。同样，影响出院时不良结局的因素有年龄（≤18岁与>18岁，P<0.001）、女性性别（P<0.001）、收入中位数（第四四分位数与其他，P<0.001）、种族（非裔美国人与非非裔美国人，P<0.02）、保险类型（医疗保险与私人保险，P<0.001）、合并症（高与低，P<0.001）、医院病例量（第四四分位数与其他，P<0.001）、医生病例量（第四四分位数与其他，P<0.0001）、医院类型（教学医院与非教学医院）、医院床位规模（小与大，P<0.001）、医院所在地区（东北部与其他地区，P<0.001）和医院位置（城市与农村，P<0.001）。
在全国范围内，EDH的发病率没有显著变化。然而，其成本正在迅速增加。
