Torikashvili Johnathan V, Read Meagan D, Janjua Haroon M, Parikh Rajavi, Kuo Paul C, Grimsley Emily A
Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, United States of America.
Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, United States of America.
Surg Open Sci. 2024 Mar 13;18:129-133. doi: 10.1016/j.sopen.2024.03.001. eCollection 2024 Mar.
The COVID-19 pandemic necessitated changes in processes of care, which significantly impacted surgical care. This study evaluated the impact of these changes on patient outcomes and costs for non-elective major lower extremity amputations (LEA).
The 2019-2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent non-elective major LEA. Per-patient inflation-adjusted costs were collected. Patient cohorts were established based on Florida COVID-19 mortality rates: COVID-heavy (CH) included nine months with the highest mortality, COVID-light (CL) included nine months with the lowest mortality, and pre-COVID (PC) included nine months before COVID (2019). Outcomes included in-hospital patient outcomes and hospitalization cost.
6132 patients were included (1957 PC, 2104 CH, and 2071 CL). Compared to PC, there was increased patient acuity at presentation, but morbidity (31%), mortality (4%), and length of stay (median 12 [8-17] days) were unchanged during CH and CL. Additionally, costs significantly increased during the pandemic; median total cost rose 9%, room costs increased by 16%, ICU costs rose by 15%, and operating room costs rose by 15%. When COVID-positive patients were excluded, cost of care was still significantly higher during CH and CL.
Despite maintaining pre-pandemic standards, as evidenced by unchanged outcomes, the pandemic led to increased costs for patients undergoing non-elective major LEA. This was likely due to increased patient acuity, resource strain, and supply chain shortages during the pandemic.
While patient outcomes for non-elective major lower extremity amputations remained consistent during the COVID-19 pandemic, healthcare costs significantly increased, likely due to increased patient acuity and heightened pressures on resources and supply chains. These findings underscore the need for informed policy changes to mitigate the financial impact on patients and healthcare systems for future public health emergencies.
新型冠状病毒肺炎（COVID-19）大流行使得医疗流程发生改变，这对手术治疗产生了重大影响。本研究评估了这些变化对非择期下肢大截肢（LEA）患者的预后及费用的影响。
查询2019 - 2021年佛罗里达州医疗保健管理局数据库，纳入接受非择期下肢大截肢的成年患者。收集经通胀调整后的人均费用。根据佛罗里达州COVID-19死亡率建立患者队列：高COVID死亡率组（CH）包括死亡率最高的9个月，低COVID死亡率组（CL）包括死亡率最低的9个月，COVID前组（PC）包括COVID之前的9个月（2019年）。结局指标包括住院患者结局和住院费用。
共纳入6132例患者（1957例PC组、2104例CH组和2071例CL组）。与PC组相比，就诊时患者病情严重程度增加，但CH组和CL组的发病率（31%）、死亡率（4%）及住院时间（中位数12[8 - 17]天）未发生变化。此外，大流行期间费用显著增加；总费用中位数上涨9%，病房费用增加16%，重症监护病房费用上涨15%，手术室费用上涨15%。排除COVID阳性患者后，CH组和CL组的医疗费用仍显著更高。
尽管结局未变，表明维持了大流行前的标准，但大流行导致接受非择期下肢大截肢患者的费用增加。这可能是由于大流行期间患者病情严重程度增加、资源紧张和供应链短缺所致。
在COVID-19大流行期间，非择期下肢大截肢患者的结局保持一致，但医疗费用显著增加，可能原因是患者病情严重程度增加以及资源和供应链压力加大。这些发现强调需要做出明智的政策改变，以减轻未来公共卫生紧急事件对患者和医疗系统的财务影响。
