Narayan Mayur, Tesoriero Ronald, Bruns Brandon R, Klyushnenkova Elena N, Chen Hegang, Diaz Jose J
Division of Acute Care Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.
Division of Acute Care Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.
J Am Coll Surg. 2016 Apr;222(4):691-9. doi: 10.1016/j.jamcollsurg.2016.01.054. Epub 2016 Feb 8.
Trauma centers (TCs) have been shown to provide lifesaving, but more expensive, care when compared with non-TCs (NTC). Limited data exist about the economic impact of emergency general surgery (EGS) patients on health care systems. We hypothesized that the economic burden would be higher for EGS patients managed at TCs vs NTCs.
The Maryland Health Services Cost Review Commission database was queried from 2009 to 2013. The American Association for the Surgery of Trauma EGS ICD-9 codes were used to define the top 10 EGS diagnoses. Demographic characteristics, TC designation, severity of illness, and hospital charge data were collected. Differences in total charges between TCs and NTCs were analyzed by Wilcoxon test using SAS 9.3 software (SAS Institute).
A total of 435,623 patients were included. Median age was 61 years (interquartile range 47 to 76 years) and 55.9% were female. Median length of stay was 4 days; 90.3% were admitted via emergency department; and overall mortality was 5.1%. Overall median charges were $11,081 for TC vs $8,264 for NTC (p < 0.0001). Minor, moderate, major, and extreme severities of illness all had higher charges at TC vs NTC with no ICU admissions, respectfully ($5,908 vs $5,243; $7,051 vs $6,003; $10,501 vs $8,777; and $23, 997 vs $18,381; p < 0.001). Care at TCs was nearly twice as expensive if patients were admitted to the ICU, even when stratifying by severity of illness.
Emergency general surgery patients treated at TCs incurred increased costs compared with NTCs, independent of patient severity. These costs nearly doubled for those admitted to the ICU. As acute care surgery grows as a specialty, additional investigation is required to better understand the reasons for this cost differential.
与非创伤中心（NTC）相比，创伤中心（TC）已被证明能提供挽救生命但费用更高的治疗。关于急诊普通外科（EGS）患者对医疗系统的经济影响的数据有限。我们假设，在创伤中心接受治疗的EGS患者的经济负担会高于在非创伤中心接受治疗的患者。
查询了2009年至2013年马里兰州医疗服务成本审查委员会的数据库。使用美国创伤外科协会的EGS ICD - 9编码来定义前10种EGS诊断。收集了人口统计学特征、创伤中心指定情况、疾病严重程度和医院收费数据。使用SAS 9.3软件（SAS研究所）通过Wilcoxon检验分析创伤中心和非创伤中心之间总费用的差异。
共纳入435,623名患者。中位年龄为61岁（四分位间距47至76岁），55.9%为女性。中位住院时间为4天；90.3%通过急诊科入院；总体死亡率为5.1%。创伤中心的总体中位费用为11,081美元，而非创伤中心为8,264美元（p < 0.0001）。在未入住重症监护病房（ICU）的情况下，疾病轻微、中度、重度和极重度患者在创伤中心的费用均高于非创伤中心（分别为5,908美元对5,243美元；7,051美元对6,003美元；10,501美元对8,777美元；23,997美元对18,381美元；p < 0.001）。即使按疾病严重程度分层，若患者入住ICU，创伤中心的治疗费用几乎是非创伤中心的两倍。
与非创伤中心相比，在创伤中心接受治疗的急诊普通外科患者费用增加，与患者严重程度无关。对于入住ICU的患者，这些费用几乎翻倍。随着急性护理外科作为一个专科的发展，需要进一步调查以更好地理解这种费用差异的原因。
