Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Heart Center, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Clin Res Cardiol. 2021 May;110(5):658-666. doi: 10.1007/s00392-020-01789-5. Epub 2020 Dec 17.
Frailty is a common characteristic of patients undergoing transcatheter mitral valve repair (TMVR). It is unclear whether the physical vulnerability of frail patients translates into increased procedural health care utilization.
Frailty was assessed using the Fried criteria in 229 patients undergoing TMVR using the MitraClip system at our institution and associations with total costs and costs by cost centers within the hospital incurred during periprocedural hospitalization were examined. Frail patients (n = 107, 47%) compared to non-frail patients showed significantly higher total costs [median/interquartile range, excluding implant costs: 7,337 € (5,911-9,814) vs 6,238 € (5,584-7,499), p = 0.001], with a difference in means of 2,317 €. Frailty was the only clinical baseline characteristic with significant association with total costs. Higher total costs in frail patients were attributable primarily to longer stay on intermediate/intensive care unit (3.8 ± 5.7 days in frail vs 2.1 ± 1.7 days in non-frail, p = 0.003), but also to costs of clinical chemistry and physiotherapy. The prolonged stay on intermediate/intensive care unit in frail patients was attributable to postprocedural complications such as bleeding, kidney injury, infections and cardiovascular instability.
Frailty is associated with a mean 32% increase of hospital costs in patients undergoing TMVR, which is primarily the result of a prolonged recovery and increased vulnerability to complications. These findings are valuable for a hospital's total cost calculation and resource allocation planning. Since frailty is regarded a potentially reversible health state, preventive interventions may help reduce costs in frail patients.
衰弱是行经导管二尖瓣修复术（TMVR）患者的常见特征。衰弱患者的身体脆弱性是否会转化为手术期间医疗保健利用率的增加尚不清楚。
在我们的机构中，使用 MitraClip 系统对 229 例行 TMVR 的患者进行衰弱评估，使用 Fried 标准评估，并检查与围手术期住院期间的总费用以及医院内各成本中心的费用之间的关联。与非虚弱患者相比，虚弱患者（n=107，47%）的总费用明显更高[中位数/四分位距，不包括植入物费用：7337 欧元（5911-9814 欧元）比 6238 欧元（5584-7499 欧元），p=0.001]，平均值差异为 2317 欧元。衰弱是与总费用具有显著相关性的唯一临床基线特征。虚弱患者的总费用较高主要归因于在中级/重症监护病房的停留时间更长（虚弱患者为 3.8±5.7 天，非虚弱患者为 2.1±1.7 天，p=0.003），但也与临床化学和物理治疗的费用有关。虚弱患者在中级/重症监护病房的长时间停留归因于术后并发症，如出血、肾损伤、感染和心血管不稳定。
衰弱与行 TMVR 患者的平均 32%的医院成本增加相关，这主要是由于康复时间延长和对并发症的易感性增加所致。这些发现对于医院的总成本计算和资源分配规划具有重要价值。由于衰弱被认为是一种潜在可逆转的健康状态，预防干预措施可能有助于减少虚弱患者的成本。
