高医院衰弱风险评分与破裂颅内动脉瘤血管内治疗后的并发症增加和医疗资源利用增加相关。

Higher Hospital Frailty Risk Score is associated with increased complications and healthcare resource utilization after endovascular treatment of ruptured intracranial aneurysms.

机构信息

Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.

Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.

出版信息

J Neurointerv Surg. 2023 Mar;15(3):255-261. doi: 10.1136/neurintsurg-2021-018484. Epub 2022 Mar 15.

DOI:10.1136/neurintsurg-2021-018484

PMID:35292571

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8931798/

Abstract

AIM

To use the Hospital Frailty Risk Score (HFRS) to investigate the impact of frailty on complication rates and healthcare resource utilization in patients who underwent endovascular treatment of ruptured intracranial aneurysms (IAs).

METHODS

A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. All adult patients (≥18 years) undergoing endovascular treatment for IAs after subarachnoid hemorrhage were identified using ICD-10-CM codes. Patients were categorized into frailty cohorts: low (HFRS <5), intermediate (HFRS 5-15) and high (HFRS >15). Patient demographics, adverse events, length of stay (LOS), discharge disposition, and total cost of admission were assessed. Multivariate logistic regression analysis was used to identify independent predictors of prolonged LOS, increased cost, and non-routine discharge.

RESULTS

Of the 33 840 patients identified, 7940 (23.5%) were found to be low, 20 075 (59.3%) intermediate and 5825 (17.2%) high frailty by HFRS criteria. The rate of encountering any adverse event was significantly greater in the higher frailty cohorts (low: 59.9%; intermediate: 92.4%; high: 99.2%, p<0.001). There was a stepwise increase in mean LOS (low: 11.7±8.2 days; intermediate: 18.7±14.1 days; high: 26.6±20.1 days, p<0.001), mean total hospital cost (low: $62 888±37 757; intermediate: $99 670±63 446; high: $134 937±80 331, p<0.001), and non-routine discharge (low: 17.3%; intermediate: 44.4%; high: 69.4%, p<0.001) with increasing frailty. On multivariate regression analysis, a similar stepwise impact was found in prolonged LOS (intermediate: OR 2.38, p<0.001; high: OR 4.49, p<0.001)], total hospital cost (intermediate: OR 2.15, p<0.001; high: OR 3.62, p<0.001), and non-routine discharge (intermediate: OR 2.13, p<0.001; high: OR 4.17, p<0.001).

CONCLUSIONS

Our study found that greater frailty as defined by the HFRS was associated with increased complications, LOS, total costs, and non-routine discharge.

摘要

目的

使用医院衰弱风险评分（HFRS）研究衰弱对接受颅内破裂动脉瘤（IA）血管内治疗患者并发症发生率和医疗资源利用的影响。

方法

使用 2016-2019 年全国住院患者样本数据库进行回顾性队列研究。使用 ICD-10-CM 代码识别所有蛛网膜下腔出血后接受血管内治疗的 IA 的成年患者（≥18 岁）。根据 HFRS 将患者分为衰弱队列：低（HFRS<5）、中（HFRS 5-15）和高（HFRS>15）。评估患者的人口统计学特征、不良事件、住院时间（LOS）、出院去向和入院总费用。采用多变量逻辑回归分析确定 LOS 延长、费用增加和非常规出院的独立预测因素。

结果

在 33840 名患者中，根据 HFRS 标准，有 7940 名（23.5%）为低、20075 名（59.3%）为中、5825 名（17.2%）为高衰弱。在较高衰弱队列中，不良事件的发生率明显更高（低：59.9%；中：92.4%；高：99.2%，p<0.001）。平均 LOS（低：11.7±8.2 天；中：18.7±14.1 天；高：26.6±20.1 天，p<0.001）、平均总住院费用（低：62888±37757 美元；中：99670±63446 美元；高：134937±80331 美元，p<0.001）和非常规出院（低：17.3%；中：44.4%；高：69.4%，p<0.001）随着衰弱程度的增加而逐渐增加。多元回归分析发现，LOS 延长（中：OR 2.38，p<0.001；高：OR 4.49，p<0.001）、总住院费用（中：OR 2.15，p<0.001；高：OR 3.62，p<0.001）和非常规出院（中：OR 2.13，p<0.001；高：OR 4.17，p<0.001）也存在类似的逐步影响。