使用盐水耦合双极密封器进行开放性肝切除术治疗肝脏恶性肿瘤：医疗资源利用与成本
Use of a saline-coupled bipolar sealer open liver resection for hepatic malignancy: Medical resource use and costs.
作者信息
Nichols Christine I, Vose Joshua G
机构信息
Christine I Nichols, Joshua G Vose, Medtronic Advanced Energy, 180 International Drive, Portsmouth, NH 03801, United States.
出版信息
World J Gastroenterol. 2016 Dec 14;22(46):10189-10197. doi: 10.3748/wjg.v22.i46.10189.
AIM
To evaluate outcomes associated with use of a saline coupled bipolar sealer during open partial liver resection.
METHODS
This retrospective analysis utilized the United States Premier™ insurance claims database (2010-2014). Patients were selected with codes for liver malignancy and partial hepatectomy or lobectomy. Cases were defined by use the saline-coupled bipolar sealer; controls had no use. A Propensity Score algorithm was used to match one case to five controls. A deviation-based cost modeling (DBCM) approach provided an estimate of cost-effectiveness.
RESULTS
One hundred and forty-four cases and 720 controls were available for analysis. Patients in the case cohort received fewer transfusions controls (18.1% 29.4%, = 0.007). In DBCM, more patients in the case cohort experienced "on-course" hospitalizations (53.5% 41.9%, = 0.009). The cost calculation showed an average savings in total hospitalization costs of $1027 for cases controls. In multivariate analysis, cases had lower odds of receiving a transfusion (OR = 0.44, 95%CI: 0.27-0.71, = 0.0008).
CONCLUSION
Use of a saline-coupled bipolar sealer was associated with a greater proportion of patients with an "on course" hospitalization.
目的
评估在开放性部分肝切除术中使用生理盐水耦合双极密封器的相关结果。
方法
这项回顾性分析利用了美国Premier™保险理赔数据库（2010 - 2014年）。选取有肝恶性肿瘤及部分肝切除术或肝叶切除术编码的患者。病例由使用生理盐水耦合双极密封器定义；对照组未使用。采用倾向评分算法将1例病例与5例对照进行匹配。基于偏差的成本建模（DBCM）方法提供了成本效益估计。
结果
144例病例和720例对照可供分析。病例组患者输血次数少于对照组（18.1%对29.4%，P = 0.007）。在DBCM中，病例组更多患者经历“正常疗程”住院（53.5%对41.9%，P = 0.009）。成本计算显示病例组总住院成本平均比对照组节省1027美元。多因素分析中，病例组输血几率较低（OR = 0.44，95%CI：0.27 - 0.71，P = 0.0008）。
结论
使用生理盐水耦合双极密封器与更高比例的“正常疗程”住院患者相关。
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