College of Health, Medicine and Wellbeing, School of Medicine and Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia.
Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
BJS Open. 2022 Jul 7;6(4). doi: 10.1093/bjsopen/zrac046.
Somatic syndromes are present in 30 per cent of primary healthcare populations and are associated with increased health service use and health costs. Less is known about secondary care surgical inpatient populations.
This was a prospective longitudinal cohort study (n = 465) of consecutive adult admissions with an episode of non-traumatic abdominal pain, to the Acute General Surgical Unit at a tertiary hospital in New South Wales, Australia. Somatic symptom severity (SSS) was dichotomized using the Patient Health Questionnaire (PHQ)-15 with a cut-off point of 10 or higher (medium-high SSS) and compared pre-admission and during admission. Total healthcare utilization and direct costs were stratified by a PHQ-15 score of 10 or higher. Linear regression was used to examine differences in costs, and a multivariable linear regression was used to examine the relationship of PHQ-15 scores of 10 or higher to total costs, reported as mean total costs of care and percentage difference (95 per cent confidence intervals).
Fifty-two per cent (n = 242) of participants had a medium-high SSS with greater pre-admission and admission interval health service costs. Mean total direct costs of care were 25 per cent (95 per cent c.i. 8 to 44 per cent) higher in the PHQ-15 score of 10 or higher group: mean difference €1401.93 (95 per cent c.i. €512.19 to €2273.67). The multivariable model showed a significant association of PHQ-15 scores of 10 or higher (2.1 per cent; 0.2-4.1 per cent greater for each one-point increase in score) with total hospital costs, although the strongest contributions to cost were older age, operative management, and lower socioeconomic level. There was a linear relationship between PHQ scores and total healthcare costs.
Medium to high levels of somatic symptoms are common in surgical inpatients with abdominal pain and are independently associated with greater healthcare utilization.
躯体综合征在初级保健人群中占 30%，与增加卫生服务利用和卫生费用有关。关于二级保健外科住院患者人群，了解较少。
这是一项前瞻性纵向队列研究（n=465），连续纳入澳大利亚新南威尔士州一家三级医院急性普通外科病房因非创伤性腹痛住院的成年患者。采用患者健康问卷（PHQ）-15 量表将躯体症状严重程度（SSS）分为二分类，截断值为 10 或更高（中高度 SSS），并在入院前和入院期间进行比较。根据 PHQ-15 评分 10 或更高，对总医疗保健利用率和直接成本进行分层。采用线性回归分析比较成本差异，采用多变量线性回归分析 PHQ-15 评分 10 或更高与总费用的关系，以总护理费用的平均值和百分比差异（95%置信区间）表示。
52%（n=242）的参与者存在中高度 SSS，入院前和入院间隔的卫生服务费用更高。PHQ-15 评分 10 或更高组的总直接医疗保健费用平均高出 25%（95%置信区间 8%至 44%）：平均差异为 1401.93 欧元（95%置信区间 512.19 欧元至 2273.67 欧元）。多变量模型显示 PHQ-15 评分 10 或更高（每增加 1 分增加 2.1%，95%置信区间为 0.2%至 4.1%）与总住院费用显著相关，尽管对费用贡献最大的是年龄较大、手术治疗和较低的社会经济水平。PHQ 评分与总医疗保健费用呈线性关系。
中高度躯体症状在腹痛外科住院患者中较为常见，与更多的卫生服务利用独立相关。
