围手术期呼吸事件是否会增加儿科日间手术患者的住院时间和住院费用？

Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?

机构信息

Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

出版信息

PLoS One. 2021 May 13;16(5):e0251433. doi: 10.1371/journal.pone.0251433. eCollection 2021.

DOI:10.1371/journal.pone.0251433

PMID:33984031

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8118274/

Abstract

OBJECTIVE

We examined the consequences of perioperative respiratory event (PRE) in terms of hospitalization and hospital cost in children who underwent ambulatory surgery.

METHODS

This subgroup analysis of a prospective cohort study (ClinicalTrials.gov: NCT02036021) was conducted in children aged between 1 month and 14 years who underwent ambulatory surgery between November 2012 and December 2013. Exposure was the presence of PRE either intraoperatively or in the postanesthetic care unit or both. The primary outcome was length of stay after surgery. The secondary outcome was excess hospital cost excluding surgical cost. Financial information was also compared between PRE and non-PRE. Directed acyclic graphs were used to select the covariates to be included in the multivariate regression models. The predictors of length of stay and excess hospital cost between PRE and non-PRE children are presented as adjusted odds ratio (OR) and cost ratio (CR), respectively with 95% confidence interval (CI).

RESULTS

Sixty-three PRE and 249 non-PRE patients were recruited. In the univariate analysis, PRE was associated with length of stay (p = 0.004), postoperative oxygen requirement (p <0.001), and increased hospital charge (p = 0.006). After adjustments for age, history of snoring, American Society of Anesthesiologists physical status, type of surgery and type of payment, preoperative planned admission had an effect modification with PRE (p <0.001). The occurrence of PRE in the preoperative unplanned admission was associated with 24-fold increased odds of prolonged hospital stay (p <0.001). PRE was associated with higher excess hospital cost (CR = 1.35, p = 0.001). The mean differences in contribution margin for total procedure (per patient) (PRE vs non-PRE) differed significantly (mean = 1,523; 95% CI: 387, 2,658 baht).

CONCLUSION

PRE with unplanned admission was significantly associated with prolonged length of stay whereas PRE regardless of unplanned admission increased hospital cost by 35% in pediatric ambulatory surgery.

TRIAL REGISTRATION

ClinicalTrials.gov registration number NCT02036021.

摘要

目的

我们研究了围手术期呼吸事件（PRE）对接受日间手术的儿童住院和住院费用的影响。

方法

这是一项前瞻性队列研究（ClinicalTrials.gov：NCT02036021）的亚组分析，纳入 2012 年 11 月至 2013 年 12 月期间接受日间手术的 1 个月至 14 岁儿童。暴露因素为手术期间或麻醉后护理单元内或两者均存在 PRE。主要结局为手术后的住院时间。次要结局为手术费用以外的超额住院费用。还比较了 PRE 和非 PRE 儿童之间的财务信息。有向无环图用于选择多元回归模型中包含的协变量。PRE 和非 PRE 儿童的住院时间和超额住院费用的预测因素分别以调整后的比值比（OR）和成本比（CR）表示，置信区间（CI）为 95%。

结果

共纳入 63 例 PRE 患者和 249 例非 PRE 患者。在单因素分析中，PRE 与住院时间（p = 0.004）、术后吸氧需求（p <0.001）和住院费用增加（p = 0.006）有关。在调整年龄、打鼾史、美国麻醉医师协会身体状况、手术类型和付款类型后，PRE 对术前计划入院有影响（p <0.001）。术前非计划入院时发生 PRE 与住院时间延长的几率增加 24 倍相关（p <0.001）。PRE 与更高的超额住院费用相关（CR = 1.35，p = 0.001）。每个患者的总手术程序边际贡献均值（PRE 与非 PRE）差异显著（平均 = 1523 泰铢；95%CI：387，2658 泰铢）。