Eamer Gilgamesh J, Clement Fiona, Pederson Jenelle L, Churchill Thomas A, Khadaroo Rachel G
From the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Eamer, Pederson, Churchill, Khadaroo); the Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alta. (Clement); the School of Public Health, University of Alberta, Edmonton, Alta. (Gilgamesh); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Khadaroo).
Can J Surg. 2018 Feb;61(1):19-27. doi: 10.1503/cjs.002617. Epub 2017 Dec 1.
As populations age, more elderly patients will undergo surgery. Frailty and complications are considered to increase in-hospital cost in older adults, but little is known on costs following discharge, particularly those borne by the patient. We examined risk factors for increased cost and the type of costs accrued following discharge in elderly surgical patients.
Acute abdominal surgery patients aged 65 years and older were prospectively enrolled. We assessed baseline clinical characteristics, including Clinical Frailty Scale (CFS) scores. We calculated 6-month cost (in Canadian dollars) from patient-reported use following discharge according to the validated Health Resource Utilization Inventory. Primary outcomes were 6-month overall cost and cost for health care services, medical products and lost productive hours. Outcomes were log-transformed and assessed in multivariable generalized linear and zero-inflated negative binomial regressions and can be interpreted as adjusted ratios (AR). Complications were assessed according to Clavien-Dindo classification.
We included 150 patients (mean age 75.5 ± 7.6 yr; 54.1% men) in our analysis; 10.8% had major and 43.2% had minor complications postoperatively. The median 6-month overall cost was $496 (interquartile range $140-$1948). Disaggregated by cost type, frailty independently predicted increasing costs of health care services (AR 1.76, 95% confidence interval [CI] 1.43-2.18, < 0.001) and medical products (AR 1.61, 95% CI 1.15-2.25, = 0.005), but decreasing costs in lost productive hours (AR 0.39, = 0.002). Complications did not predict increased cost.
Frail patients accrued higher health care services and product costs, but lower costs from lost productive hours. Interventions in elderly surgical patients should consider patient-borne cost in older adults and lost productivity in less frail patients.
NCT02233153 (clinicaltrials.gov).
随着人口老龄化，越来越多的老年患者将接受手术。衰弱和并发症被认为会增加老年人的住院费用，但对于出院后的费用，尤其是患者承担的费用，人们了解甚少。我们研究了老年外科患者出院后费用增加的风险因素以及所产生的费用类型。
前瞻性纳入65岁及以上的急性腹部手术患者。我们评估了基线临床特征，包括临床衰弱量表（CFS）评分。根据经过验证的健康资源利用清单，我们计算了患者报告的出院后6个月的费用（以加元计）。主要结局是6个月的总费用以及医疗保健服务、医疗产品和生产时间损失的费用。对结局进行对数转换，并在多变量广义线性和零膨胀负二项回归中进行评估，结果可解释为调整比值（AR）。根据Clavien-Dindo分类评估并发症。
我们的分析纳入了150例患者（平均年龄75.5±7.6岁；54.1%为男性）；10.8%的患者术后出现严重并发症，43.2%的患者出现轻微并发症。6个月总费用的中位数为496加元（四分位间距为140 - 1948加元）。按费用类型分类，衰弱独立预测医疗保健服务费用增加（AR 1.76，95%置信区间[CI] 1.43 - 2.18，P < 0.001）和医疗产品费用增加（AR 1.61，95% CI 1.15 - 2.25，P = 0.005），但生产时间损失费用减少（AR 0.39，P = 0.002）。并发症并未预测费用增加。
衰弱患者产生的医疗保健服务和产品费用较高，但生产时间损失费用较低。对老年外科患者的干预应考虑老年人患者承担的费用以及较不衰弱患者的生产力损失。
NCT02233153（clinicaltrials.gov）。
