手术部位感染的影响——成本分析。

The impact of surgical site infection-a cost analysis.

机构信息

Department of General, Visceral and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.

Innlandet Hospital Trust, Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Brumunddal, Norway.

出版信息

Langenbecks Arch Surg. 2022 Mar;407(2):819-828. doi: 10.1007/s00423-021-02346-y. Epub 2021 Oct 14.

DOI:10.1007/s00423-021-02346-y

PMID:34651239

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8933305/

Abstract

PURPOSE

Surgical site infection (SSI) occurs in up to 25% of patients after elective laparotomy. We aimed to determine the effect of SSI on healthcare costs and patients' quality of life.

METHODS

In this post hoc analysis based on the RECIPE trial, we studied a 30-day postoperative outcome of SSI in a single-center, prospective randomized controlled trial comparing subcutaneous wound irrigation with 0.04% polyhexanide to 0.9% saline after elective laparotomy. Total medical costs were analyzed accurately per patient with the tool of our corporate controlling team which is based on diagnosis-related groups in Germany.

RESULTS

Between November 2015 and May 2018, 456 patients were recruited. The overall rate of SSI was 28.2%. Overall costs of inpatient treatment were higher in the group with SSI: median 16.685 €; 19.703 USD (IQR 21.638 €; 25.552 USD) vs. median 11.235 €; 13.276 USD (IQR 11.564 €; 13.656 USD); p < 0.001. There was a difference in surgery costs (median 6.664 €; 7.870 USD with SSI vs. median 5.040 €; 5.952 USD without SSI; p = 0.001) and costs on the surgical ward (median 8.404 €; 9.924 USD with SSI vs. median 4.690 €; 5.538 USD without SSI; p < 0.001). Patients with SSI were less satisfied with the cosmetic result (4.3% vs. 16.2%; p < 0.001). Overall costs for patients who were irrigated with saline were median 12.056 €; 14.237 USD vs. median 12.793 €; 15.107 USD in the polyhexanide group (p = 0.52).

CONCLUSION

SSI after elective laparotomy increased hospital costs substantially. This is an additional reason why the prevention of SSI is important. Overall costs for intraoperative wound irrigation with saline were comparable with polyhexanide.

摘要

目的

择期剖腹手术后，高达 25%的患者会发生手术部位感染（SSI）。我们旨在确定 SSI 对医疗保健成本和患者生活质量的影响。

方法

在这项基于 RECIPE 试验的事后分析中，我们研究了一项单中心前瞻性随机对照试验的 30 天术后 SSI 结果，该试验比较了在择期剖腹手术后，用 0.04%聚己定对皮下伤口进行冲洗与用 0.9%生理盐水冲洗的效果。我们的公司控制团队的工具对每位患者的总医疗费用进行了准确分析，该工具基于德国的诊断相关组。

结果

2015 年 11 月至 2018 年 5 月，共招募了 456 名患者。SSI 的总体发生率为 28.2%。发生 SSI 的组住院治疗的总费用更高：中位数 16685 欧元；19703 美元（IQR 21638 欧元；25552 美元）与中位数 11235 欧元；13276 美元（IQR 11564 欧元；13656 美元）；p<0.001。手术费用存在差异（有 SSI 的中位数为 6664 欧元；7870 美元，无 SSI 的中位数为 5040 欧元；5952 美元；p=0.001），手术病房费用也存在差异（有 SSI 的中位数为 8404 欧元；9924 美元，无 SSI 的中位数为 4690 欧元；5538 美元；p<0.001）。发生 SSI 的患者对美容效果的满意度较低（4.3%对 16.2%；p<0.001）。接受生理盐水冲洗的患者的总费用中位数为 12056 欧元；14237 美元，而接受聚己定冲洗的患者的总费用中位数为 12793 欧元；15107 美元（p=0.52）。