Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
CTU Bern, University of Bern, Bern, Switzerland.
Neurocrit Care. 2024 Feb;40(1):251-261. doi: 10.1007/s12028-023-01723-3. Epub 2023 Apr 26.
The correlation between the standardized resource use ratio (SRUR) and standardized hospital mortality ratio (SMR) for neurosurgical emergencies is not known. We studied SRUR and SMR and the factors affecting these in patients with traumatic brain injury (TBI), nontraumatic intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).
We extracted data of patients treated in six university hospitals in three countries (2015-2017). Resource use was measured as SRUR based on purchasing power parity-adjusted direct costs and either intensive care unit (ICU) length of stay (costSRUR) or daily Therapeutic Intervention Scoring System scores (costSRUR). Five a priori defined variables reflecting differences in structure and organization between the ICUs were used as explanatory variables in bivariable models, separately for the included neurosurgical diseases.
Out of 28,363 emergency patients treated in six ICUs, 6,162 patients (22%) were admitted with a neurosurgical emergency (41% nontraumatic ICH, 23% SAH, 13% multitrauma TBI, and 23% isolated TBI). The mean costs for neurosurgical admissions were higher than for nonneurosurgical admissions, and the neurosurgical admissions corresponded to 23.6-26.0% of all direct costs related to ICU emergency admissions. A higher physician-to-bed ratio was associated with lower SMRs in the nonneurosurgical admissions but not in the neurosurgical admissions. In patients with nontraumatic ICH, lower costSRURs were associated with higher SMRs. In the bivariable models, independent organization of an ICU was associated with lower costSRURs in patients with nontraumatic ICH and isolated/multitrauma TBI but with higher SMRs in patients with nontraumatic ICH. A higher physician-to-bed ratio was associated with higher costSRURs for patients with SAH. Larger units had higher SMRs for patients with nontraumatic ICH and isolated TBI. None of the ICU-related factors were associated with costSRURs in nonneurosurgical emergency admissions.
Neurosurgical emergencies constitute a major proportion of all emergency ICU admissions. A lower SRUR was associated with higher SMR in patients with nontraumatic ICH but not for the other diagnoses. Different organizational and structural factors seemed to affect resource use for the neurosurgical patients compared with nonneurosurgical patients. This emphasizes the importance of case-mix adjustment when benchmarking resource use and outcomes.
神经外科急症的标准化资源利用比（SRUR）与标准化医院死亡率比（SMR）之间的相关性尚不清楚。我们研究了创伤性脑损伤（TBI）、非创伤性颅内出血（ICH）和蛛网膜下腔出血（SAH）患者的 SRUR 和 SMR 以及影响这些因素的因素。
我们从三个国家的六所大学医院提取了 2015-2017 年期间治疗的患者数据。资源使用是根据购买力平价调整后的直接成本以及重症监护病房（ICU）住院时间（costSRUR）或每日治疗干预评分系统评分（costSRUR）来衡量的。在双变量模型中，我们使用了五个事先定义的变量来反映 ICU 之间的结构和组织差异，这些变量分别针对纳入的神经外科疾病进行了单独分析。
在六所 ICU 中治疗的 28363 名急诊患者中，有 6162 名（22%）因神经外科急症入院（41%非创伤性 ICH、23%SAH、13%多发创伤性 TBI 和 23%单纯性 TBI）。神经外科入院的平均费用高于非神经外科入院的费用，神经外科入院的费用占 ICU 急诊入院的所有直接费用的 23.6-26.0%。医生与床位的比例较高与非神经外科入院的 SMR 较低有关，但与神经外科入院无关。在非创伤性 ICH 患者中，较低的 costSRUR 与较高的 SMR 相关。在双变量模型中，ICU 独立组织与非创伤性 ICH 和孤立/多发创伤性 TBI 患者的 costSRUR 较低有关，但与非创伤性 ICH 患者的 SMR 较高有关。医生与床位的比例较高与 SAH 患者的 costSRUR 较高有关。较大的单位在非创伤性 ICH 和单纯性 TBI 患者中 SMR 较高。在非神经外科急诊入院患者中，没有任何 ICU 相关因素与 costSRUR 相关。
神经外科急症占所有急诊 ICU 入院的主要比例。非创伤性 ICH 患者的较低 SRUR 与较高的 SMR 相关，但其他诊断则不然。与非神经外科患者相比，不同的组织和结构因素似乎会影响神经外科患者的资源利用。这强调了在基准资源利用和结果时进行病例组合调整的重要性。
