From the Prisma Health/University of South Carolina School of Medicine.
University of South Carolina School of Medicine, Columbia, SC.
Ann Plast Surg. 2024 Jun 1;92(6S Suppl 4):S408-S412. doi: 10.1097/SAP.0000000000003954.
The healthcare costs for treatment of community-acquired decubitus ulcers accounts for $11.6 billion in the United States annually. Patients with stage 3 and 4 decubitus ulcers are often treated inefficiently prior to reconstructive surgery while physicians attempt to optimize their condition (debridement, fecal/urinary diversion, physical therapy, nutrition, and obtaining durable medical goods). We hypothesized that hospital costs for inpatient optimization of decubitus ulcers would significantly differ from outpatient optimization costs, resulting in significant financial losses to the hospital and that transitioning optimization to an outpatient setting could reduce both total and hospital expenditures. In this study, we analyzed and compared the financial expenditures of optimizing patients with decubitus ulcers in an inpatient setting versus maximizing outpatient utilization of resources prior to reconstruction.
Encounters of patients with stage 3 or 4 decubitus ulcers over a 5-year period were investigated. These encounters were divided into two groups: Group 1 included patients who were optimized totally inpatient prior to reconstructive surgery; group 2 included patients who were mostly optimized in an outpatient setting and this encounter was a planned admission for their reconstructive surgery. Demographics, comorbidities, paralysis status, and insurance carriers were collected for all patients. Financial charges and reimbursements were compared among the groups.
Forty-five encounters met criteria for inclusion. Group 1's average hospital charges were $500,917, while group 2's charges were $134,419. The cost of outpatient therapeutic items for patient optimization prior to wound closure was estimated to be $10,202 monthly. When including an additional debridement admission for group 2 patients (average of $108,031), the maximal charges for total care was $252,652, and hospital reimbursements were similar between group 1 and group 2 ($65,401 vs $50,860 respectively).
The data derived from this investigation strongly suggests that optimizing patients in an outpatient setting prior to decubitus wound closure versus managing the patients totally on an inpatient basis will significantly reduce hospital charges, and hence costs, while minimally affecting reimbursements to the hospital.
在美国，每年用于治疗社区获得性褥疮的医疗保健费用达 116 亿美元。在接受重建手术之前，患有 3 期和 4 期褥疮的患者通常治疗效率低下，而医生则试图优化他们的病情（清创、粪便/尿液引流、物理治疗、营养和获得耐用医疗用品）。我们假设，住院患者优化褥疮的费用将与门诊优化费用有显著差异，这将给医院带来巨大的财务损失，而将优化过渡到门诊环境可以降低总费用和医院支出。在这项研究中，我们分析并比较了在住院环境下优化 3 期或 4 期褥疮患者与在重建前最大限度地利用门诊资源的患者的财务支出。
对 5 年内患有 3 期或 4 期褥疮的患者进行了调查。这些患者被分为两组：组 1 为在接受重建手术前完全在住院环境下优化的患者；组 2 为主要在门诊环境下优化的患者，此次住院是为了接受重建手术。收集了所有患者的人口统计学、合并症、瘫痪状态和保险类型。比较了各组的财务费用和报销情况。
45 次就诊符合纳入标准。组 1 的平均住院费用为 500917 美元，而组 2 的费用为 134419 美元。在伤口闭合前优化患者的门诊治疗项目的费用估计为每月 10202 美元。当包括组 2 患者的额外清创入院费用（平均为 108031 美元）时，总护理的最高费用为 252652 美元，组 1 和组 2 的医院报销费用相似（分别为 65401 美元和 50860 美元）。
从这项调查中得出的数据强烈表明，在褥疮伤口闭合前将患者在门诊环境下进行优化，而不是完全在住院环境下进行管理，将显著降低医院费用，从而降低成本，同时对医院的报销影响最小。
