重症监护服务在接受重大外科手术的医疗保险受益人中的使用情况。
Use of Intensive Care Services for Medicare Beneficiaries Undergoing Major Surgical Procedures.
作者信息
Wunsch Hannah, Gershengorn Hayley B, Cooke Colin R, Guerra Carmen, Angus Derek C, Rowe John W, Li Guohua
机构信息
From the Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (H.W.); Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Anesthesiology, Columbia University, New York, New York (H.W., C.G., G.L.); Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York (H.G.); Department of Medicine, University of Michigan, Ann Arbor, Michigan (C.R.C.); Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (D.C.A.); and Department of Health Policy and Management (J.W.R.) and Department of Epidemiology (G.L.), Mailman School of Public Health, Columbia University, New York, New York.
出版信息
Anesthesiology. 2016 Apr;124(4):899-907. doi: 10.1097/ALN.0000000000001024.
BACKGROUND
Use of intensive care after major surgical procedures and whether routinely admitting patients to intensive care units (ICUs) improve outcomes or increase costs is unknown.
METHODS
The authors examined frequency of admission to an ICU during the hospital stay for Medicare beneficiaries undergoing selected major surgical procedures: elective endovascular abdominal aortic aneurysm (AAA) repair, cystectomy, pancreaticoduodenectomy, esophagectomy, and elective open AAA repair. The authors compared hospital mortality, length of stay, and Medicare payments for patients receiving each procedure in hospitals admitting patients to the ICU less than 50% of the time (low use), 50 to 89% (moderate use), and 90% or greater (high use), adjusting for patient and hospital factors.
RESULTS
The cohort ranged from 7,878 patients in 162 hospitals for esophagectomies to 69,989 patients in 866 hospitals for endovascular AAA. Overall admission to ICU ranged from 35.6% (endovascular AAA) to 71.3% (open AAA). Admission to ICU across hospitals ranged from less than 5% to 100% of patients for each surgical procedure. There was no association between hospital use of intensive care and mortality for any of the five surgical procedures. There was a consistent association between high use of intensive care with longer length of hospital stay and higher Medicare payments only for endovascular AAA.
CONCLUSIONS
There is little consensus regarding the need for intensive care for patients undergoing major surgical procedures and no relationship between a hospital's use of intensive care and hospital mortality. There is also no consistent relationship across surgical procedures between use of intensive care and either length of hospital stay or payments for care.
背景
大手术后重症监护的使用情况以及常规将患者收入重症监护病房（ICU）是否能改善预后或增加成本尚不清楚。
方法
作者研究了接受特定大手术的医疗保险受益人的住院期间入住ICU的频率：择期血管内腹主动脉瘤（AAA）修复术、膀胱切除术、胰十二指肠切除术、食管切除术和择期开放性AAA修复术。作者比较了在ICU使用率低于50%（低使用率）、50%至89%（中等使用率）和90%或更高（高使用率）的医院中接受每种手术的患者的医院死亡率、住院时间和医疗保险支付情况，并对患者和医院因素进行了调整。
结果
队列研究的患者数量从162家医院的7878例食管切除术患者到866家医院的69989例血管内AAA患者不等。总体入住ICU的比例从35.6%（血管内AAA）到71.3%（开放性AAA）不等。每家医院每种手术入住ICU的患者比例从不到5%到100%不等。对于这五种手术中的任何一种，医院的重症监护使用情况与死亡率之间均无关联。仅对于血管内AAA，重症监护的高使用率与更长的住院时间和更高的医疗保险支付之间存在一致的关联。
结论
对于接受大手术的患者是否需要重症监护几乎没有共识，医院的重症监护使用情况与医院死亡率之间也没有关系。在不同手术中，重症监护的使用与住院时间或护理费用之间也没有一致的关系。
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