Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Monash School of Medicine, Clayton, Australia.
Arch Osteoporos. 2022 Apr 6;17(1):59. doi: 10.1007/s11657-022-01103-y.
End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rates. As these patients significantly skew healthcare financing in a bundled care payment (BCP) program, a risk stratified approach to BCPs could be done to take into account the difference in resources required.
End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rate. Hip fracture patients with ESRD may significantly skew healthcare financing in a bundled care payment (BCP) program.
ESRD patients undergoing hip fracture surgery from June 2007 to June 2012 within a tertiary hospital in Singapore were identified and matched to two other controls without ESRD based on secondary features of sex, age, fracture type, and surgery performed. Data was collected for American Society of Anesthesiologist (ASA) score, duration of surgery (DOS), length of stay (LOS), 30-day and 1-year mortality, and the presence of 10 other comorbidities: diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), ischemic heart disease (IHD), arrhythmia (ARR), cerebrovascular disease (CVA), dementia (DEM), asthma (ASTH), peripheral vascular disease (PVD), and anemia (ANE) from electronic medical records. Costs were retrieved from the gross acute hospitalization bill.
Forty-one ESRD patients were successfully matched with 82 controls. Patients with ESRD had higher ASA scores (3 vs 2, p = 0.0001), had 75% higher LOS (21 vs 12 days, p < 0.0001), were associated with 67% higher healthcare expenditure (median $20542 vs $12236, p < 0.0001), and 1-year mortality (OR: 19.6, p < 0.0001). ESRD patients had an average of 4.1 comorbidities per patient compared to 1.84 in the control group.
ESRD is an outsized factor on the outcome of hip fracture patients who have markedly higher and more variable healthcare utilization.
终末期肾病（ESRD）是髋部骨折发生的独立危险因素，与更高的死亡率和并发症发生率相关。由于这些患者在捆绑式护理支付（BCP）计划中极大地影响了医疗保健的资金投入，因此可以采用风险分层方法来考虑所需资源的差异。
在新加坡的一家三级医院，确定了 2007 年 6 月至 2012 年 6 月期间接受髋部骨折手术的 ESRD 患者，并根据性别、年龄、骨折类型和手术类型等次要特征与另外两名无 ESRD 的对照组进行匹配。收集了美国麻醉医师协会（ASA）评分、手术持续时间（DOS）、住院时间（LOS）、30 天和 1 年死亡率以及其他 10 种合并症的存在情况：糖尿病（DM）、高血压（HTN）、高血脂（HLD）、缺血性心脏病（IHD）、心律失常（ARR）、脑血管疾病（CVA）、痴呆（DEM）、哮喘（ASTH）、周围血管疾病（PVD）和贫血（ANE）的信息，这些数据来自电子病历。费用从总急性住院费用中检索。
成功匹配了 41 名 ESRD 患者和 82 名对照组患者。ESRD 患者的 ASA 评分更高（3 分 vs 2 分，p=0.0001），住院时间更长（21 天 vs 12 天，p<0.0001），医疗支出更高（中位数为$20542 美元 vs $12236 美元，p<0.0001），1 年死亡率更高（OR：19.6，p<0.0001）。ESRD 患者的平均合并症为 4.1 种，而对照组为 1.84 种。
ESRD 是髋部骨折患者结局的重要影响因素，这类患者的医疗保健利用量显著更高且更具变异性。
