Dua Anahita, Desai Sapan S, Patel Bhavin, Seabrook Gary R, Brown Kellie R, Lewis Brian, Rossi Peter J, Malinowski Michael, Lee Cheong J
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Department of Vascular Surgery, Southern Illinois University, Springfield, IL.
Ann Vasc Surg. 2016 May;33:144-8. doi: 10.1016/j.avsg.2015.11.026. Epub 2016 Feb 23.
This study aimed to identify factors that drive increasing health-care costs associated with the management of critical limb ischemia in elective inpatients.
Patients with a primary diagnosis code of critical limb ischemia (CLI) were identified from the 2001-2011 Nationwide Inpatient Sample. Demographics, CLI management, comorbidities, complications (bleeding, surgical site infection [SSI]), length of stay, and median in-hospital costs were reviewed. Statistical analysis was completed using Students' t-test and Mann-Kendall trend analysis. Costs are reported in 2011 US dollars corrected using the consumer price index.
From 2001 to 2011, there were a total of 451,823 patients who underwent open elective revascularization as inpatients for CLI. Costs to treat CLI increased by 63% ($12,560 in 2001 to $20,517 in 2011, P < 0.001 in trend analysis). Endovascular interventions were 20% more expensive compared with open surgery ($19,566 vs. $16,337, P < 0.001). Age, gender, and insurance status did not affect the cost of care. From 2001 to 2011, the number of patient comorbidities (7.56-12.40) and percentage of endovascular cases (13.4% to 27.4%) increased, accounting for a 6% annual increase in total cost despite decreased median length of stay (6 to 5 days). Patients who developed SSI had total costs 83% greater than patients without SSIs ($30,949 vs. $16,939; P < 0.001). Patients who developed bleeding complications had total costs 41% greater than nonbleeding patients ($23,779 vs. $16,821, P < 0.001). Overall, there was a 32% reduction in SSI rates but unchanged rates of bleeding complications during this period.
The cost of CLI treatment is increasing and driven by rising endovascular use, SSI, and bleeding in the in-patient population. Further efforts to reduce complications in this patient population may contribute to a reduction in health care-associated costs of treating CLI.
本研究旨在确定导致择期住院患者严重肢体缺血管理相关医疗费用增加的因素。
从2001 - 2011年全国住院患者样本中识别出主要诊断编码为严重肢体缺血（CLI）的患者。回顾了人口统计学资料、CLI管理情况、合并症、并发症（出血、手术部位感染[SSI]）、住院时间和住院费用中位数。使用学生t检验和曼 - 肯德尔趋势分析完成统计分析。费用以2011年美元计，并使用消费价格指数进行校正。
2001年至2011年，共有451,823例患者作为住院患者接受了择期开放性血管重建术治疗CLI。治疗CLI的费用增加了63%（从2001年的12,560美元增至2011年的20,517美元，趋势分析中P < 0.001）。与开放手术相比，血管内介入治疗费用高出20%（19,566美元对16,337美元，P < 0.001）。年龄、性别和保险状况不影响护理费用。2001年至2011年，患者合并症数量（7.56 - 12.40）和血管内治疗病例百分比（13.4%至27.4%）增加，尽管住院时间中位数减少（从6天降至5天），但总成本仍以每年6%的速度增长。发生SSI的患者总费用比未发生SSI的患者高83%（30,949美元对16,939美元；P < 0.001）。发生出血并发症的患者总费用比未出血患者高41%（23,779美元对16,821美元，P < 0.001）。总体而言，在此期间SSI发生率降低了32%，但出血并发症发生率未变。
CLI治疗费用在增加，且受住院患者血管内治疗使用增加、SSI和出血的驱动。进一步努力降低该患者群体的并发症可能有助于降低治疗CLI的医疗相关费用。
