围手术期低血压与随后更多的医疗资源利用相关。

Association of perioperative hypotension with subsequent greater healthcare resource utilization.

机构信息

Indiana University School of Medicine, Department of Anesthesia, 1130 West Michigan St., Indianapolis, IN 46202, USA; Richard L. Roudebush VA Medical Center, Department of Anesthesiology, 1481 W 10th St, Indianapolis, IN 46202, USA.

Wake Forest University School of Medicine, Wake Forest Baptist Health, Department of Anesthesiology, Section on Critical Care Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA; Outcomes Research Consortium, Cleveland Clinic, 9500 Euclid Avenue-P77, Cleveland, OH, 44195, USA.

出版信息

J Clin Anesth. 2021 Dec;75:110516. doi: 10.1016/j.jclinane.2021.110516. Epub 2021 Sep 15.

DOI:10.1016/j.jclinane.2021.110516

PMID:34536719

Abstract

STUDY OBJECTIVE

Determine if perioperative hypotension, a modifiable risk factor, is associated with increased postoperative healthcare resource utilization (HRU).

DESIGN

Retrospective cohort study.

SETTING

Multicenter using the Optum® electronic health record database.

PATIENTS

Patients discharged to the ward after non-cardiac, non-obstetric surgeries between January 1, 2008 and December 31, 2017 with six months of data, before and after the surgical visit.

INTERVENTIONS/EXPOSURE: Perioperative hypotension, a binary variable (presence/absence) at an absolute MAP of ≤65-mmHg, measured during surgery and within 48-h after, to dichotomize patients with greater versus lesser hypotensive exposures.

MEASUREMENTS

Short-term HRU defined by postoperative length-of-stay (LOS), discharge to a care facility, and 30-day readmission following surgery discharge. Mid-term HRU (within 6 months post-discharge) quantified via number of outpatient and emergency department (ED) visits, and readmission LOS.

MAIN RESULTS

42,800 distinct patients met study criteria and 37.5% experienced perioperative hypotension. After adjusting for study covariates including patient demographics and comorbidities, patients with perioperative hypotension had: longer LOS (4.01 vs. 3.83 days; LOS ratio, 1.05; 95% CI, 1.04-1.06), higher odds of discharge to a care facility (OR, 1.18; 95% CI, 1.12-1.24; observed rate 22.1% vs. 18.1%) and of 30-day readmission (OR, 1.22; 95% CI, 1.11-1.33; observed rate 6.2% vs. 5.0%) as compared to the non-hypotensive population (all outcomes, p < 0.001). During 6-month follow-up, patients with perioperative hypotension showed significantly greater HRU regarding number of ED visits (0.34 vs. 0.31 visits; visit ratio, 1.10; 95% CI, 1.05-1.15) and readmission LOS (1.06 vs. 0.92 days; LOS ratio, 1.15; 95% CI, 1.07-1.24) but not outpatient visits (10.47 vs. 10.82; visit ratio, 0.97; 95% CI, 0.95-0.99) compared to those without hypotension. There was no difference in HRU during the 6-month period before qualifying surgery.

CONCLUSIONS

We report a significant association of perioperative hypotension with an increase in HRU, including additional LOS and readmissions, both important contributors to overall medical costs.

摘要

研究目的

确定围手术期低血压（一种可修正的风险因素）是否与术后医疗资源利用（HRU）增加有关。

设计

回顾性队列研究。

地点

使用 Optum®电子健康记录数据库的多中心。

患者

2008 年 1 月 1 日至 2017 年 12 月 31 日期间非心脏、非产科手术后出院至病房的患者，在手术前后有 6 个月的数据。

干预/暴露：围手术期低血压，绝对平均动脉压（MAP）≤65mmHg 的二元变量（存在/不存在），在手术期间和术后 48 小时内测量，以将低血压暴露较大的患者与低血压暴露较小的患者区分开来。

测量

短期 HRU 定义为术后住院时间（LOS）、出院至护理机构以及术后 30 天再入院。中期 HRU（出院后 6 个月内）通过门诊和急诊（ED）就诊次数和再入院 LOS 来量化。

主要结果

42800 名符合研究标准的患者中有 37.5%出现围手术期低血压。在校正包括患者人口统计学和合并症在内的研究协变量后，与非低血压患者相比，患有围手术期低血压的患者：LOS 更长（4.01 天 vs. 3.83 天；LOS 比值，1.05；95%置信区间，1.04-1.06），更有可能出院至护理机构（OR，1.18；95%置信区间，1.12-1.24；观察率 22.1% vs. 18.1%）和 30 天再入院（OR，1.22；95%置信区间，1.11-1.33；观察率 6.2% vs. 5.0%）（所有结局，p<0.001）。在 6 个月的随访期间，与非低血压患者相比，围手术期低血压患者的 ED 就诊次数（0.34 次 vs. 0.31 次；就诊比值，1.10；95%置信区间，1.05-1.15）和再入院 LOS（1.06 天 vs. 0.92 天；LOS 比值，1.15；95%置信区间，1.07-1.24）明显更高，但门诊就诊次数（10.47 次 vs. 10.82 次；就诊比值，0.97；95%置信区间，0.95-0.99）没有差异。在有资格接受手术前的 6 个月期间，HRU 没有差异。