回顾性评估专用创伤杂交手术室的价值。

Retrospective value assessment of a dedicated, trauma hybrid operating room.

机构信息

From the Department of Surgery (J.A.B., T.J.L., M.D.R., A.M.M., P.A.E., G.R.U., R.S.S.) and Department of Medicine (M.M.R.), University of Florida Health, Gainesville, Florida.

出版信息

J Trauma Acute Care Surg. 2023 Jun 1;94(6):814-822. doi: 10.1097/TA.0000000000003873. Epub 2023 Jan 23.

DOI:10.1097/TA.0000000000003873

PMID:36727772

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10205659/

Abstract

BACKGROUND

In traumatic hemorrhage, hybrid operating rooms offer near simultaneous performance of endovascular and open techniques, with correlations to earlier hemorrhage control, fewer transfusions, and possible decreased mortality. However, hybrid operating rooms are resource intensive. This study quantifies and describes a single-center experience with the complications, cost-utility, and value of a dedicated trauma hybrid operating room.

METHODS

This retrospective cohort study evaluated 292 consecutive adult trauma patients who underwent immediate (<4 hours) operative intervention at a Level I trauma center. A total of 106 patients treated before the construction of a hybrid operating room served as historical controls to the 186 patients treated thereafter. Demographics, hemorrhage-control procedures, and financial data as well as postoperative complications and outcomes were collected via electronic medical records. Value and incremental cost-utility ratio were calculated.

RESULTS

Demographics and severity of illness were similar between cohorts. Resuscitative endovascular occlusion of the aorta was more frequently used in the hybrid operating room. Hemorrhage control occurred faster (60 vs. 49 minutes, p = 0.005) and, in the 4- to 24-hour postadmission period, required less red blood cell (mean, 1.0 vs. 0 U, p = 0.001) and plasma (mean, 1.0 vs. 0 U, p < 0.001) transfusions. Complications were similar except for a significant decrease in pneumonia (7% vs. 4%, p = 0.008). Severe complications (Clavien-Dindo classification, ≥3) were similar. Across the patient admission, costs were not significantly different ($50,023 vs. $54,740, p = 0.637). There was no change in overall value (1.00 vs. 1.07, p = 0.778).

CONCLUSION

The conversion of our standard trauma operating room to an endovascular hybrid operating room provided measurable improvements in hemorrhage control, red blood cell and plasma transfusions, and postoperative pneumonia without significant increase in cost. Value was unchanged.

LEVEL OF EVIDENCE

Economic/Value-Based Evaluations; Level III.

摘要

背景

在创伤性出血中，杂交手术室可以同时进行血管内和开放技术，与更早的出血控制、更少的输血和可能降低的死亡率相关。然而，杂交手术室需要大量资源。本研究定量描述了一家专门的创伤杂交手术室的并发症、成本效益和价值的单中心经验。

方法

这项回顾性队列研究评估了 292 名在一级创伤中心接受紧急（<4 小时）手术干预的成年创伤患者。106 名在杂交手术室建成前接受治疗的患者作为历史对照，与 186 名此后接受治疗的患者进行比较。通过电子病历收集人口统计学、出血控制程序和财务数据以及术后并发症和结果。计算了价值和增量成本效益比。

结果

两组的人口统计学和疾病严重程度相似。在杂交手术室中更频繁地使用了主动脉腔内修复术。更快地控制了出血（60 分钟与 49 分钟，p=0.005），并且在入院后 4-24 小时期间，需要更少的红细胞（平均，1.0 单位与 0 单位，p=0.001）和血浆（平均，1.0 单位与 0 单位，p<0.001）输注。并发症相似，除肺炎发生率显著降低（7%与 4%，p=0.008）外。严重并发症（Clavien-Dindo 分类，≥3）相似。整个患者住院期间，成本无显著差异（$50023 与 $54740，p=0.637）。总体价值无变化（1.00 与 1.07，p=0.778）。