12264University of Maryland School of Medicine, 137889R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
National Study Center for Trauma and Emergency Medical Systems, Center for Shock, Trauma and Anesthesiology Research, Baltimore, MD, USA.
Am Surg. 2022 Aug;88(8):1783-1791. doi: 10.1177/00031348221083948. Epub 2022 Apr 4.
Older adults (OAs; ≥ 65 years) comprise a growing population in the United States and are anticipated to require an increasing number of emergency general surgery procedures (EGSPs). The aims of this study were to identify the frequency of EGSPs and compare cost of care in OAs managed at teaching hospitals (THs) vs nonteaching hospitals (NTHs).
A retrospective review of data from the Maryland Health Services Cost Review Commission database from 2009 to 2018 for OAs undergoing EGSPs was undertaken. Data collected included demographics, all patient-refined (APR)-severity of illness (SOI), APR-risk of mortality (ROM), Charlson Comorbidity Index (CCI), EGSPs (partial colectomy (PC), small bowel resection, cholecystectomy, operative management of peptic ulcers, lysis of adhesions, appendectomy, and laparotomy, categorized hospital charges, length of stay (LOS), and mortality.
Of the 55,401 OAs undergoing EGSPs in this study, 28,575 (51.6%) were treated at THs and 26,826 (48.4%) at NTHs. OAs at THs presented with greater APR-ROM (major 25.6% vs 24.9%, extreme 22.6% vs 22.0%, P=.01), and CCI (3.1±3 vs 2.7±2.8, P<.001) compared to NTHs. Lysis of adhesions, cholecystectomy, and PC comprised the overall most common EGSPs. Older adults at THs incurred comparatively higher median hospital charges for every EGSP due to increased room charges and LOS. Mortality was higher at THs (6.13% vs 5.33%, P<.001).
While acuity of illness appears similar, cost of undergoing EGSPs for OAs is higher in THs vs NTHs due to increased LOS. Future work is warranted to determine and mitigate factors that increase LOS at THs.
老年人（≥65 岁）在美国的人口中占比越来越大，预计需要进行越来越多的急诊普通外科手术（EGSP）。本研究的目的是确定 EGSP 的频率，并比较在教学医院（TH）和非教学医院（NTH）接受治疗的老年人的护理成本。
对 2009 年至 2018 年马里兰州卫生服务成本审查委员会数据库中接受 EGSP 的老年人进行回顾性研究。收集的数据包括人口统计学资料、所有患者细化（APR）严重程度（SOI）、APR 死亡率风险（ROM）、Charlson 合并症指数（CCI）、EGSP（部分结肠切除术（PC）、小肠切除术、胆囊切除术、消化性溃疡的手术治疗、粘连松解术、阑尾切除术和剖腹术）、分类住院费用、住院时间（LOS）和死亡率。
在这项研究中，55401 名接受 EGSP 的老年人中，28575 名（51.6%）在 TH 接受治疗，26826 名（48.4%）在 NTH 接受治疗。TH 组的老年人 APR-ROM 更大（主要为 25.6%比 24.9%，极端为 22.6%比 22.0%，P=0.01），CCI 更高（3.1±3 比 2.7±2.8，P<.001）。粘连松解术、胆囊切除术和 PC 构成了最常见的 EGSP。由于住院时间延长和住院费用增加，TH 接受 EGSP 的老年人每例手术的平均住院费用相对较高。TH 的死亡率更高（6.13%比 5.33%，P<.001）。
尽管疾病严重程度似乎相似，但由于 LOS 延长，TH 治疗老年人的 EGSP 成本高于 NTH。需要进一步研究以确定和减轻导致 TH 中 LOS 增加的因素。
