Chen Yi-Ren, Johnson Eli, Ugiliweneza Beatrice, Kim Lily H, Shpanskaya Katie, Boakye Maxwell, Tse Victor
Department of Neurosurgery, Stanford University Medical Center, Stanford, USA.
Department of Neurosurgery, Duke University School of Medicine, Durham, USA.
Cureus. 2024 Dec 9;16(12):e75412. doi: 10.7759/cureus.75412. eCollection 2024 Dec.
BACKGROUND/OBJECTIVE: Intracranial gunshot wounds (GSW) are often fatal, with most patients dying before intervention can occur. Surgical management, when indicated, results in decreased mortality. We sought to assess the neurosurgical outcomes and economic costs of intracranial GSW.
We conducted a retrospective analysis using the longitudinal claims Truven MarketScan® database (IBM) from 2000 to 2016. Mortality was the primary outcome of interest. Complications, length of stay, and payment were secondary outcomes. Multivariable logistic and linear regression analyses were performed to assess the relationship between age, gender, insurance type, and the number of comorbidities in the outcomes measured.
We identified 315 patients (median age 34.0 years; interquartile range (IQR)=24, 48; 32.06% female) who received craniotomy or craniectomy for intracranial GSW. Mortality occurred in 44 patients (13.97%) and 234 patients (74.29%) experienced complications. The median length of stay was 13 days (IQR=5, 25 days), and the median cost was $70,624.00 (IQR=$32,378.00; $163,437.00). Increases in the Elixhauser index by one-comorbidity increments were associated with increased length of stay (risk ratio (RR)=1.207; 95% confidence interval (CI)=1.106-1.317) and payment (RR=1.135; 95% CI=1.036-1.243). Patients with respiratory complications, excluding infection, experienced an increased risk of mortality (odds ratio (OR)=3.486; 95% CI=1.623-7.485), length of stay (RR=1.649; 95% CI=1.321-2.060), and payment (RR=2.085; 95% CI=1.652-2.631).
Although these findings must be interpreted in the context of the limitations inherent to studies using national administrative data, the current study provides additional insight into the relationship between patient characteristics and outcomes after surgery for intracranial GSW.
背景/目的：颅内枪伤（GSW）通常是致命的，大多数患者在能够进行干预之前就已死亡。在有指征时进行手术治疗可降低死亡率。我们试图评估颅内GSW的神经外科治疗结果和经济成本。
我们使用IBM公司的纵向索赔Truven MarketScan®数据库对2000年至2016年的数据进行了回顾性分析。死亡率是主要关注的结果。并发症、住院时间和费用是次要结果。进行多变量逻辑回归和线性回归分析，以评估年龄、性别、保险类型和合并症数量与所测量结果之间的关系。
我们确定了315例因颅内GSW接受开颅手术或颅骨切除术的患者（中位年龄34.0岁；四分位间距（IQR）=24,48；女性占32.06%）。44例患者（13.97%）死亡，234例患者（74.29%）出现并发症。中位住院时间为13天（IQR=5,25天），中位费用为70,624.00美元（IQR=32,378.00美元；163,437.00美元）。埃利克斯豪泽指数每增加一种合并症，住院时间（风险比（RR）=1.207；95%置信区间（CI）=1.106 - 1.317）和费用（RR=1.135；95%CI=1.036 - 1.243）都会增加。除感染外有呼吸并发症的患者死亡风险（优势比（OR）=3.486；95%CI=1.623 - 7.485）、住院时间（RR=1.649；95%CI=1.321 - 2.060）和费用（RR=2.085；95%CI=1.652 - 2.631）都会增加。
尽管这些发现必须结合使用国家行政数据的研究所固有的局限性来解释，但本研究为颅内GSW手术后患者特征与治疗结果之间的关系提供了更多见解。
