Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
CTU Bern, University of Bern, Bern, Switzerland.
J Crit Care. 2022 Oct;71:154110. doi: 10.1016/j.jcrc.2022.154110. Epub 2022 Jul 6.
The resource use of cardiac surgery and neurosurgery patients likely differ from other ICU patients. We evaluated the relevance of these patient groups on overall ICU resource use.
Secondary analysis of 69,862 patients in 17 ICUs in Finland, Estonia, and Switzerland in 2015-2017. Direct costs of care were allocated to patients using daily Therapeutic Intervention Scoring System (TISS) scores and ICU length of stay (LOS). The ratios of observed to severity-adjusted expected resource use (standardized resource use ratios; SRURs), direct costs and outcomes were assessed before and after excluding cardiac surgery or cardiac and neurosurgery.
Cardiac surgery and neurosurgery, performed only in university hospitals, represented 22% of all ICU admissions and 15-19% of direct costs. Cardiac surgery and neurosurgery were excluded with no consistent effect on SRURs in the whole cohort, regardless of cost separation method. Excluding cardiac surgery or cardiac surgery plus neurosurgery had highly variable effects on SRURs of individual university ICUs, whereas the non-university ICU SRURs decreased.
Cardiac and neurosurgery have major effects on the cost structure of multidisciplinary ICUs. Extending SRUR analysis to patient subpopulations facilitates comparison of resource use between ICUs and may help to optimize resource allocation.
心脏手术和神经外科患者的资源利用情况可能与其他 ICU 患者不同。我们评估了这些患者群体对整体 ICU 资源利用的相关性。
对芬兰、爱沙尼亚和瑞士 17 个 ICU 中 2015-2017 年的 69862 名患者进行二次分析。使用每日治疗干预评分系统（TISS）评分和 ICU 住院时间（LOS）将护理的直接成本分配给患者。在排除心脏手术或心脏和神经外科手术前后，评估观察到的与严重程度调整后资源利用（标准化资源利用比；SRUR）、直接成本和结果的比值。
仅在大学医院进行的心脏手术和神经外科手术占所有 ICU 入院人数的 22%，占直接成本的 15-19%。无论采用何种成本分离方法，在整个队列中，排除心脏手术或心脏手术加神经外科手术对 SRUR 均无一致影响。排除心脏手术或心脏手术加神经外科手术对个别大学 ICU 的 SRUR 有很大影响，而非大学 ICU 的 SRUR 则下降。
心脏和神经外科对多学科 ICU 的成本结构有重大影响。将 SRUR 分析扩展到患者亚群有助于比较 ICU 之间的资源利用情况，并可能有助于优化资源分配。
