胃膨出闭合技术的医院费用差异。
Variation in hospital costs for gastroschisis closure techniques.
机构信息
University of Washington School of Medicine, Seattle, WA, 98195, USA.
Institute for Disease Modeling, Bellevue, WA, 98005, USA; Seattle Children's Research Institute, Seattle, WA, 98101, USA.
出版信息
Am J Surg. 2020 May;219(5):764-768. doi: 10.1016/j.amjsurg.2020.03.003. Epub 2020 Mar 9.
BACKGROUND
In newborns with gastroschisis, both primary repair and delayed fascial closure with initial silo placement are considered safe with similar outcomes although cost differences have not been explored.
METHODS
A retrospective review was performed of newborns admitted with gastroschisis at a single center from 2011 to 2016. Demographic, clinical, and cost data during the initial hospitalization were collected. Differences between procedure costs and clinical endpoints were analyzed using multivariable linear regression adjusting for prematurity, complicated gastroschisis, and performance of additional operations.
RESULTS
80 patients with gastroschisis met inclusion criteria. Rates of primary fascial, primary umbilical cord closure, and delayed closure were 14%, 65%, and 21%, respectively. Delayed closure was associated with an increase in total hospital costs by 57% compared to primary repair (p < 0.001). In addition, delayed closure was associated with increased total and NICU LOS (p < 0.05), parenteral nutrition duration (p = 0.02), ventilator days (p < 0.001), time to goal enteral feeds (p = 0.01), and all cost sub-categories except ward room costs (p < 0.01).
CONCLUSION
Delayed fascial closure was associated with significantly greater hospital costs during the index admission.
背景
在新生儿先天性腹壁裂中，一期修补和延期筋膜闭合加初始造口袋放置均被认为是安全的，且具有相似的结果，尽管尚未探讨成本差异。
方法
对 2011 年至 2016 年在单一中心就诊的先天性腹壁裂新生儿进行了回顾性研究。收集了初始住院期间的人口统计学、临床和成本数据。使用多元线性回归分析调整早产儿、复杂型先天性腹壁裂和其他操作的情况下，分析手术费用和临床终点的差异。
结果
80 例先天性腹壁裂患儿符合纳入标准。一期筋膜修复、一期脐带结扎和延期修复的比例分别为 14%、65%和 21%。与一期修复相比，延期修复使总住院费用增加了 57%（p<0.001）。此外，延期修复与总住院时间和新生儿重症监护病房住院时间延长（p<0.05）、肠外营养时间延长（p=0.02）、呼吸机使用时间延长（p<0.001）、达到目标肠内喂养时间延长（p=0.01）以及除病房费用外的所有成本亚组增加相关（p<0.01）。
结论
延期筋膜闭合与指数住院期间的显著更高的住院费用相关。
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