Parker Robert K, Otoki Kemunto, Many Heath R, Parker Andrea S, Shrime Mark G
Department of Surgery, Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, RI.
Department of Surgery, Tenwek Hospital, Bomet, Kenya.
Surgery. 2022 Nov;172(5):1401-1406. doi: 10.1016/j.surg.2022.08.006. Epub 2022 Sep 8.
The financial burden of surgery is substantial worldwide. Postoperative complications increase costs in high-resource settings, but this is not well studied in other settings. Our objective was to review the financial impact of postoperative complications.
Patients undergoing emergency gastrointestinal operations at a center in Kenya were reviewed between January 2017 and June 2019. In a cost analysis, we ascertained the outcome of total hospital costs, adjusted for inflation, and converted to international dollars using purchasing power parities. Costs were analyzed for their association with a postoperative complication, defined using standardized criteria. We calculated the Africa Surgical Outcomes Study surgical risk scores and clustered for discharge diagnosis in a mixed-effects generalized linear model accounting for confounding factors related to costs and complications.
A total of 361 individuals had cost data available. The cohort had 251 men (69.5%) and 110 women (30.5%) with a median age of 41 years (interquartile range: 29-57 years). A total of 122 (33.8%) patients experienced a postoperative complication with an overall all-cause mortality rate of 10.5%. The median total cost of hospitalization was 1,949 (interquartile range: 1,516-2,788) international dollar purchasing power parities. When controlling for patient factors and diagnoses, patients who did not develop complications had costs of 2,119 (95% confidence interval 1,898-2,340) compared to costs of 3,747 (95% confidence interval 3,327-4,167) for patients who developed a postoperative complication, leading to a 77% increase of 1,628 international dollar purchasing power parities for patients with complications.
Our findings demonstrated a substantial financial burden generated by postoperative complications in patients undergoing emergency gastrointestinal operations. Reducing complications could allow cost savings, an important consideration in variable-resource settings.
手术的经济负担在全球范围内都很巨大。在资源丰富的环境中，术后并发症会增加成本，但在其他环境中对此研究较少。我们的目的是评估术后并发症的经济影响。
对2017年1月至2019年6月期间在肯尼亚一家中心接受急诊胃肠道手术的患者进行回顾。在成本分析中，我们确定了经通货膨胀调整后的总住院费用结果，并使用购买力平价转换为国际美元。分析成本与术后并发症的关联，并发症采用标准化标准定义。我们计算了非洲外科手术结果研究的手术风险评分，并在考虑与成本和并发症相关的混杂因素的混合效应广义线性模型中对出院诊断进行聚类。
共有361人有可用的成本数据。该队列中有251名男性（69.5%）和110名女性（30.5%），中位年龄为41岁（四分位间距：29 - 57岁）。共有122名（33.8%）患者发生了术后并发症，总体全因死亡率为10.5%。住院总费用的中位数为1949（四分位间距：1516 - 2788）国际美元购买力平价。在控制患者因素和诊断后，未发生并发症的患者费用为2119（95%置信区间1898 - 2340），而发生术后并发症的患者费用为3747（95%置信区间3327 - 4167），这导致并发症患者的国际美元购买力平价增加了77%，即1628。
我们的研究结果表明，急诊胃肠道手术患者术后并发症会产生巨大的经济负担。减少并发症可以节省成本，这在资源可变的环境中是一个重要的考虑因素。
