Department of Infection Management, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Ann Palliat Med. 2022 Feb;11(2):431-441. doi: 10.21037/apm-21-1825. Epub 2021 Oct 25.
Extracorporeal membrane oxygenation (ECMO) is a highly invasive procedure and a high-cost medical measure, but the economic impact of nosocomial infection after ECMO support remains largely uninvestigated.
We constructed a retrospective cohort of all patients hospitalized at the First Affiliated Hospital of Nanjing Medical University from 2013 to 2020 who had ECMO supported clinical samples. Propensity score matching (PSM) was used to control the impact of potential confounding variables, including demographics, commodities, and treatment, and to estimate the economic burden of nosocomial infection after ECMO support.
There were 194 patients with ECMO support, 136 patients had no infection after ECMO, 38 patients had infection after ECMO, of which 97.4% was lower respiratory tract infection. Compared with patients among ECMO non infection group, the main reasons for ECMO treatment of patients among ECMO infection group were supportive treatment of cardiac dysfunction (63.16% vs. 42.31%, P=0.021) and longer use of catheter (13.74±14.97 vs. 15.97±14.33 days, P=0.034). The total hospital expenses for patients among ECMO infection group and ECMO non infection group were about $55,878 and $51,277 respectively. Patients with ECMO infection had significantly higher radiate expenses, operational expenses and anesthetic expenses than those among ECMO non infection group ($119.06 vs. $69.32, P=0.025; $6,458.81 vs. $4,882.49, P=0.034; $331.62 vs. $145.56, P=0.030).
Our study demonstrates that the incidence of nosocomial infection after ECMO support was relatively high, which did not lead to high total hospital expenses, but lead to higher radiate expenses, operational expenses and anesthetic expenses.
体外膜肺氧合（ECMO）是一种高度侵入性的程序和高成本的医疗措施，但 ECMO 支持后的医院感染的经济影响在很大程度上仍未得到调查。
我们构建了一个回顾性队列，包括 2013 年至 2020 年在南京医科大学第一附属医院接受 ECMO 支持的所有住院患者的临床样本。采用倾向评分匹配（PSM）来控制潜在混杂变量的影响，包括人口统计学、商品和治疗，并估计 ECMO 支持后的医院感染的经济负担。
共有 194 名患者接受了 ECMO 支持，136 名患者在 ECMO 后没有感染，38 名患者在 ECMO 后感染，其中 97.4%是下呼吸道感染。与 ECMO 非感染组患者相比，ECMO 感染组患者进行 ECMO 治疗的主要原因是心脏功能障碍的支持性治疗（63.16%比 42.31%，P=0.021）和更长时间的导管使用（13.74±14.97 天比 15.97±14.33 天，P=0.034）。ECMO 感染组和 ECMO 非感染组患者的总住院费用分别约为 55878 美元和 51277 美元。与 ECMO 非感染组相比，ECMO 感染组患者的放射费用、手术费用和麻醉费用显著更高（119.06 美元比 69.32 美元，P=0.025；6458.81 美元比 4882.49 美元，P=0.034；331.62 美元比 145.56 美元，P=0.030）。
我们的研究表明，ECMO 支持后的医院感染发生率相对较高，但并未导致总住院费用增加，而是导致放射费用、手术费用和麻醉费用增加。
