关节置换术后治疗期内手术部位感染的经济负担。
Economic burden of surgical site infections within the episode of care following joint replacement.
机构信息
Smith & Nephew, Inc., 150 Minuteman Road, Andover, MA, 01810, USA.
Smith & Nephew, Inc., Hull, UK.
出版信息
J Orthop Surg Res. 2019 Jun 27;14(1):196. doi: 10.1186/s13018-019-1224-8.
BACKGROUND
Recent policy initiatives, including Bundled Payments for Care Improvement (BPCI) Initiative by the Centers for Medicare and Medicaid Health Services (CMS), encourage healthcare providers to manage the total episode of care, rather than just the surgical episode. Surgical site infections (SSI) following total joint replacement result in preventable morbidity and suffering for patients and excess healthcare utilization for healthcare providers. This study sought to estimate the additional resources associated with SSIs within the 90-day episode of care following hip and knee joint replacement.
METHODS
Using the 2013 Nationwide Readmissions Database (NRD), healthcare resource utilization was compared between propensity score matched patient groups with and without SSI-related readmissions within the 90-day episode of care following total joint replacement.
RESULTS
Surgical site infections were associated with significantly longer hospital length of stay and increased costs following hip and knee joint replacement procedures. Generalized estimating equation regression results confirmed that additional costs associated with SSIs following both cohorts were significant, with additional hospital length of stay and costs following total hip and knee replacement procedures ranging from 4.9 to 5.2 days and $12,689 to $12,890, respectively.
CONCLUSION
Surgical site infections following total joint replacement account for significant additional healthcare resource use within the 90-day episode of care.
背景
最近的政策举措，包括医疗保险和医疗补助服务中心（CMS）的捆绑支付改善护理倡议（BPCI），鼓励医疗保健提供者管理整个护理过程，而不仅仅是手术过程。全关节置换术后的手术部位感染（SSI）会给患者带来可预防的发病率和痛苦，并给医疗保健提供者带来过度的医疗利用。本研究旨在估计髋关节和膝关节置换术后 90 天护理期间与 SSI 相关的再入院相关的额外资源。
方法
使用 2013 年全国再入院数据库（NRD），比较全关节置换术后 90 天护理期间有和无 SSI 相关再入院的倾向评分匹配患者组之间的医疗资源利用情况。
结果
SSI 与髋关节和膝关节置换手术后住院时间延长和成本增加显著相关。广义估计方程回归结果证实，两组患者的 SSI 相关额外成本均显著，全髋关节和全膝关节置换术后的额外住院时间和成本分别为 4.9 至 5.2 天和 12689 至 12890 美元。
结论
全关节置换术后的手术部位感染在 90 天的护理期间会导致大量额外的医疗资源使用。
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