Torikashvili Johnathan V, Read Meagan D, Parikh Rajavi, Zander Tyler, Kendall Melissa, Grimsley Emily A, Kuo Paul C
Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida.
Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, Bay Pines Veterans Affairs Health Care System, Bay Pines, Florida.
J Surg Res. 2025 Jun;310:315-322. doi: 10.1016/j.jss.2025.04.008. Epub 2025 May 14.
The COVID-19 pandemic significantly impacted health-care delivery and hospital financials. This study aims to identify the pandemic's effects on costs associated with nonelective major lower extremity amputation (LEA) and mediating factors influencing this cost.
The 2019-2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent nonelective LEA. Patient inflation-adjusted costs were collected. Florida COVID-19 mortality rates established 9-month COVID-heavy (CH) and COVID-light (CL) timeframes, compared to a 9-month pre-COVID (PC; 2019) timeframe. Simple mediation analysis with 2000 bootstrapping interactions evaluated patient comorbidity, surgical complications, and hospital treatment factors as potential mediators on cost.
A total of 5963 patients were included (1957 PC, 1994 CH, 2012 CL). Compared to PC, COVID timeframes had significantly increased total (+7.8%), hospital (+14.5%), intensive care unit (+14.3%), and operating room (+14.9%) costs. Simple mediation analysis identified potential influencers of increased cost: (1) acute kidney injury during CL (P = 0.03), (2) sepsis during CL (P = 0.02), and (3) electrolyte/acid-base disorders during CH and CL (P < 0.01). Sensitivity analysis (E-values) could not exclude unmeasured confounding from the model findings.
The COVID-19 pandemic led to substantial cost increases associated with nonelective major LEAs, but simple mediation analysis did not identify sensitive mediators to cost. This suggests systemic factors, such as supply chain disruptions and staffing shortages, may warrant investigation. The pandemic highlighted the need for resilient health-care systems that can address both acute and chronic care needs while mitigating inequities exacerbated by crises.
新冠疫情对医疗服务提供和医院财务状况产生了重大影响。本研究旨在确定疫情对非选择性下肢大截肢（LEA）相关成本的影响以及影响该成本的中介因素。
查询2019 - 2021年佛罗里达州医疗保健管理局数据库，以获取接受非选择性LEA的成年患者信息。收集患者经通胀调整后的成本。与新冠疫情前9个月（PC；2019年）的时间框架相比，根据佛罗里达州新冠死亡率确定了9个月新冠疫情严重（CH）和新冠疫情轻微（CL）的时间框架。采用2000次自抽样交互的简单中介分析评估患者合并症、手术并发症和医院治疗因素作为成本的潜在中介因素。
共纳入5963例患者（1957例PC组、1994例CH组、2012例CL组）。与PC组相比，新冠疫情期间的时间框架使总费用（+7.8%）、医院费用（+14.5%）、重症监护病房费用（+14.3%）和手术室费用（+14.9%）显著增加。简单中介分析确定了成本增加的潜在影响因素：（1）CL期间的急性肾损伤（P = 0.03），（2）CL期间的脓毒症（P = 0.02），以及（3）CH和CL期间的电解质/酸碱紊乱（P < 0.01）。敏感性分析（E值）不能排除模型结果中未测量的混杂因素。
新冠疫情导致非选择性下肢大截肢相关成本大幅增加，但简单中介分析未确定对成本敏感的中介因素。这表明供应链中断和人员短缺等系统性因素可能值得调查。疫情凸显了建立有弹性的医疗系统的必要性，该系统能够满足急性和慢性护理需求，同时减轻危机加剧的不平等现象。
