体外膜肺氧合治疗新生儿的先天状况与资源利用的相关性。
The association of inborn status and resource utilization among neonates who received extracorporeal membrane oxygenation.
机构信息
Department of Pediatrics, Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, UUSA.
出版信息
J Pediatr Surg. 2021 Dec;56(12):2311-2317. doi: 10.1016/j.jpedsurg.2021.02.020. Epub 2021 Feb 18.
BACKGROUND
Many studies have established that extracorporeal membrane oxygenation (ECMO) can be a cost-effective treatment in some populations, but limited data exist on which factors are associated with length of stay (LOS) and total hospital costs. This study aimed to determine if inborn (i.e., cared for in their birth hospitals) neonates who receive ECMO have different resource utilization and outcomes compared to outborn (i.e., not cared for in their birth hospitals) neonates who receive ECMO.
METHODS
A retrospective cohort study was conducted using the Healthcare Cost and Utilization Project's Kids' Inpatient Database from 1997-2012. Neonates (infants, <28 days) placed on ECMO were categorized as either inborn or outborn. Salient clinical characteristics were compared between groups. A multivariable analysis was performed to identify the factors associated with length of stay (LOS), total hospital costs, and mortality in these two patient populations.
RESULTS
Of 5,152 neonates receiving ECMO, 800 were inborn and 4,352 were outborn. Inborn neonates were more frequently diagnosed with cardiac-related diagnoses (70.5% vs 62.1%, p < 0.001). After adjusting for demographics and hospital-level factors, inborn neonates had longer hospital LOS (13.2 days, 95% CI, 8.7-18.7; p < 0.001), higher total encounter costs ($62,000, 95% CI, 40,000-85,000; p < 0.001) and higher mortality (OR 2.4, 95% CI 1.9-2.9; p < 0.001) compared to outborn neonates.
CONCLUSIONS
Inborn neonates placed on ECMO were more frequently diagnosed with cardiac-related diseases or congenital diaphragmatic hernia, had longer LOS, higher total encounter costs, and higher mortality rates relative to their outborn counterparts, and likely represent a higher risk population. These two populations of infants may be inherently different and their differences should be further explored to inform decision making about optimal site of delivery.
背景
许多研究已经证实，体外膜肺氧合（ECMO）在某些人群中是一种具有成本效益的治疗方法，但关于哪些因素与住院时间（LOS）和总住院费用相关的数据有限。本研究旨在确定在接受 ECMO 治疗的新生儿中，是否存在因出生医院不同（即出生医院接受治疗的为“在院出生”，反之则为“院外出生”）而导致资源利用和结局不同的情况。
方法
本研究采用回顾性队列研究，使用了 1997 年至 2012 年期间医疗保健成本和利用项目的儿童住院数据库。将接受 ECMO 治疗的新生儿（婴儿，<28 天）分为“在院出生”和“院外出生”。比较两组之间的显著临床特征。对多变量分析进行了分析，以确定这两种患者人群中与住院时间（LOS）、总住院费用和死亡率相关的因素。
结果
在 5152 名接受 ECMO 治疗的新生儿中，800 名为“在院出生”，4352 名为“院外出生”。“在院出生”的新生儿更常被诊断为与心脏相关的疾病（70.5% vs 62.1%，p<0.001）。在校正人口统计学和医院水平因素后，“在院出生”的新生儿住院时间更长（13.2 天，95%CI，8.7-18.7；p<0.001），总住院费用更高（62000 美元，95%CI，40000-85000 美元；p<0.001），死亡率更高（OR 2.4，95%CI 1.9-2.9；p<0.001）。
结论
与“院外出生”的新生儿相比，接受 ECMO 治疗的“在院出生”新生儿更常被诊断为与心脏相关的疾病或先天性膈疝，其 LOS 更长、总住院费用更高、死亡率更高，且可能代表着更高风险的人群。这两种婴儿人群可能存在固有差异，应进一步探讨这些差异，以为最佳分娩地点的决策提供信息。
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