美国急性外科治疗的经济足迹：对系统发展的影响。
The economic footprint of acute care surgery in the United States: Implications for systems development.
机构信息
From the Section of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery (L.M.K., L.T., D.A.S., K.L.S.), Stanford University School of Medicine, Stanford, California; Section of Burn, Trauma and Surgical Critical Care, Department of Surgery (J.M.), UT Southwestern Medical Center, Dallas, Texas; Section of General Surgery, Trauma, Surgical Critical Care, Department of Surgery (K.A.D.), Yale School of Medicine, New Haven, Connecticut; Section of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (J.D.), University of California, San Diego, California; Section of Trauma and Acute Care Surgery, Department of Surgery (A.B.), University of Kentucky College of Medicine, Lexington, Kentucky; Section of Trauma and Acute Care Surgery, Department of Surgery (A.H.), Harvard Medical School, Boston, Massachusetts; and Section of Pediatric Surgery, Department of Surgery (L.R.T.S.), Indiana University Purdue University, Indianapolis, Indiana.
出版信息
J Trauma Acute Care Surg. 2019 Apr;86(4):609-616. doi: 10.1097/TA.0000000000002181.
BACKGROUND
Acute care surgery (ACS) comprises trauma, surgical critical care, and emergency general surgery (EGS), encompassing both operative and nonoperative conditions. While the burden of EGS and trauma has been separately considered, the global footprint of ACS has not been fully characterized. We sought to characterize the costs and scope of influence of ACS-related conditions. We hypothesized that ACS patients comprise a substantial portion of the US inpatient population. We further hypothesized that ACS patients differ from other surgical and non-surgical patients across patient characteristics.
METHODS
We queried the National Inpatient Sample 2014, a nationally representative database for inpatient hospitalizations. To capture all adult ACS patients, we included adult admissions with any International Classification of Diseases-9th Rev.-Clinical Modification diagnosis of trauma or an International Classification of Diseases-9th Rev.-Clinical Modification diagnosis for one of the 16 AAST-defined EGS conditions. Weighted patient data were presented to provide national estimates.
RESULTS
Of the 29.2 million adult patients admitted to US hospitals, approximately 5.9 million (20%) patients had an ACS diagnosis. ACS patients accounted for US $85.8 billion, or 25% of total US inpatient costs (US $341 billion). When comparing ACS to non-ACS inpatient populations, ACS patients had higher rates of health care utilization with longer lengths of stay (5.9 days vs. 4.5 days, p < 0.001), and higher mean costs (US $14,466 vs. US $10,951, p < 0.001. Of all inpatients undergoing an operative procedure, 27% were patients with an ACS diagnosis. Overall, 3,186 (70%) of US hospitals cared for both trauma and EGS patients.
CONCLUSION
Acute care surgery patients comprise 20% of the inpatient population, but 25% of total inpatient costs in the United States. In addition to being costly, they overall have higher health care utilization and worse outcomes. This suggests that there is an opportunity to improve clinical trajectory for ACS patients that in turn, can affect the overall US health care costs.
LEVEL OF EVIDENCE
Epidemiologic, level III.
背景
急性护理手术（ACS）包括创伤、外科重症监护和急症普通外科（EGS），涵盖了手术和非手术条件。虽然已经分别考虑了 EGS 和创伤的负担，但 ACS 的全球影响尚未得到充分描述。我们旨在描述与 ACS 相关病症的成本和影响范围。我们假设 ACS 患者构成了美国住院患者的重要部分。我们进一步假设，ACS 患者在患者特征方面与其他外科和非外科患者有所不同。
方法
我们查询了 2014 年国家住院患者样本，这是一个全国代表性的住院患者数据库。为了捕获所有成人 ACS 患者，我们包括了成人入院时任何国际疾病分类第 9 修订版临床修正诊断为创伤或 16 种 AAST 定义的 EGS 病症之一的国际疾病分类第 9 修订版临床修正诊断。加权患者数据用于提供全国估计数。
结果
在 2920 万成年患者中，约有 590 万（20%）患者患有 ACS 诊断。ACS 患者占美国 858 亿美元，占美国 3410 亿美元总住院费用的 25%。与非 ACS 住院患者人群相比，ACS 患者的医疗利用率更高，住院时间更长（5.9 天 vs. 4.5 天，p < 0.001），平均费用更高（14466 美元 vs. 10951 美元，p < 0.001）。在所有接受手术的住院患者中，有 27%是 ACS 诊断患者。总体而言，美国 3186 家（70%）医院同时收治创伤和 EGS 患者。
结论
ACS 患者占住院患者的 20%，但占美国住院总费用的 25%。除了费用高昂外，他们的整体医疗利用率更高，结果更差。这表明有机会改善 ACS 患者的临床轨迹，从而影响美国整体医疗成本。
证据水平
流行病学，III 级。
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