Fontebasso Adam M, Figueira Sonshire, Thavorn Kednapa, Glen Peter, Lampron Jacinthe, Matar Maher
Division of General Surgery, Ottawa Hospital, Ottawa, Ontario, Canada.
Trauma Services, The Ottawa Hospital, Ottawa, Ontario, Canada.
Trauma Surg Acute Care Open. 2020 Dec 24;5(1):e000568. doi: 10.1136/tsaco-2020-000568. eCollection 2020.
Trauma is a cause of significant morbidity and mortality globally, and patients with major trauma require specialized settings for multidisciplinary care. We sought to enumerate the variability of costs of caring for patients at a Canadian level 1 trauma center.
A retrospective analysis of all adult patients admitted to The Ottawa Hospital trauma service between June 2013 and June 2018 was conducted. Hospital costs and clinical data were collected. Descriptive statistics and multivariable regression analysis using generalized linear model were performed to assess cost variation with patient characteristics. Quintile-based analyses were used to characterize patients in different cost categories. Hospital costs were reported in 2018 Canadian dollars.
A total of 2381 admissions were identified in the 5-year cohort. The mean age of patients was 50.2 years, the mean Injury Severity Score (ISS) was 18.7, the mean Charlson Comorbidity Index (CCI) score was 0.35, and the median total cost was $10 048.54. ISS and CCI score were associated with higher costs (ISS >15; p<0.0001). The most expensive mechanisms of injury (MOIs) were those involving heavy machinery (median total cost $24 074.38), pedestrians involved in road traffic collisions ($20 965.45), patients in motor vehicle collisions ($17 621.01) and motorcycle collisions ($16 220.89), and acts of self-injury ($13 903.69). Patients who experienced in-hospital adverse events were associated with higher costs (p<0.0001). Our multivariable regression analysis showed variation in costs related to male gender, penetrating/violent MOI, ISS, adverse hospital events, CCI score, urgent admission status, hospital 1-year mortality risk score, and alternate level of care designation (p0.05). Quintile-based analyses demonstrated clinically significant differences between the highest and lowest cost groups.
Major trauma was associated with high hospital costs. Modifiable and non-modifiable patient factors were shown to correlate with differing total hospital costs. These findings can aid in the development of funding strategies and resource allocation for this complex patient population.
Level III evidence for economic and value-based evaluations.
创伤是全球范围内导致严重发病和死亡的原因之一，严重创伤患者需要在专门的环境中接受多学科护理。我们试图列举加拿大一家一级创伤中心护理患者的费用差异。
对2013年6月至2018年6月期间入住渥太华医院创伤科的所有成年患者进行回顾性分析。收集医院费用和临床数据。进行描述性统计，并使用广义线性模型进行多变量回归分析，以评估费用随患者特征的变化。基于五分位数的分析用于描述不同费用类别的患者。医院费用以2018年加拿大元报告。
在5年队列中，共确定了2381例入院病例。患者的平均年龄为50.2岁，平均损伤严重程度评分（ISS）为18.7，平均查尔森合并症指数（CCI）评分为0.35，总费用中位数为10,048.54加元。ISS和CCI评分与较高的费用相关（ISS>15；p<0.0001）。最昂贵的致伤机制（MOI）包括涉及重型机械的致伤机制（总费用中位数为24,074.38加元）、道路交通事故中的行人（20,965.45加元）、机动车碰撞中的患者（17,621.01加元）和摩托车碰撞中的患者（16,220.89加元）以及自残行为（13,903.69加元）。发生院内不良事件的患者费用较高（p<0.0001）。我们的多变量回归分析显示，费用差异与男性性别、穿透性/暴力性MOI、ISS、不良医院事件、CCI评分、紧急入院状态、医院1年死亡风险评分以及替代护理级别指定有关（p0.05）。基于五分位数的分析表明，最高费用组和最低费用组之间存在临床显著差异。
严重创伤与高昂的医院费用相关。可改变和不可改变的患者因素与不同的总医院费用相关。这些发现有助于为这一复杂患者群体制定资金策略和资源分配方案。
经济和基于价值评估的III级证据。
