van den Bosch Tijmen D, Meyer Maximilian A, Haagsma Juanita A, Heng Marilyn, Leenen Loek P H, Hietbrink Falco, Houwert R Marijn, Kromkamp Marjan, Nelen Stijn D
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2025 May 19;51(1):209. doi: 10.1007/s00068-025-02868-w.
The purpose of this study was to quantify the impact of psychiatric comorbidity on in-hospital costs after multitrauma.
A retrospective single-center cohort study identified adult trauma patients with an Injury Severity Score (ISS) ≥ 16, who entered the hospital between January 2018 and December 2019. Descriptive statistics were assessed for patient characteristics, injury characteristics, and injury outcomes. Bivariate analysis was performed for in-hospital costs between patients with and without psychiatric comorbidity. The psychiatric cohort was then further divided into different sub-cohorts by status of their psychiatric comorbidity: 'Acute' for patients with no known history of psychiatric illness who required inpatient psychiatric consultation for a newly diagnosed or suspected psychiatric illness, 'Stable' for patients with a prior psychiatric history that did not require inpatient psychiatric consultation, and 'Chronic' for patients with a prior psychiatric history that required continued inpatient psychiatric consultation. Baseline demographic and in-hospital cost data was compared between these cohorts.
Of the 616 patients meeting inclusion criteria, 94 patients (15.3%) either suffered from pre-existing psychiatric illness, needed psychiatric consultation during hospitalization, or suffered both pre-existent from a psychiatric illness and needed psychiatric consultation during hospitalization. The psychiatric cohort generated significantly higher total in-hospital costs than the control cohort (median costs: €22.000 versus €15.200, respectively (p < 0.01). In particular, the Acute psychiatric cohort generated the highest hospital expenses (median total in-hospital costs €47.000). Multivariable regression analyses did not reveal psychiatric comorbidity as an independent predictor of higher in-hospital costs (p = 0.88). Instead, the duration of hospital stay (p < 0.01), ISS (p < 0.01), and the number of total surgical interventions (p < 0.01) independently predicted higher total in-hospital costs.
Although in-hospital costs of multitrauma patients were higher among patients with psychiatric comorbidity, psychiatric comorbidity does not independently predict increased in-hospital costs for patients after multitrauma. Instead, higher in-hospital costs are due to longer inpatient stay, higher ISS and greater number of surgical interventions among those with psychiatric comorbidity.
本研究的目的是量化精神疾病合并症对多发伤后住院费用的影响。
一项回顾性单中心队列研究纳入了2018年1月至2019年12月期间入院、损伤严重程度评分（ISS）≥16的成年创伤患者。对患者特征、损伤特征和损伤结局进行描述性统计分析。对有和没有精神疾病合并症的患者的住院费用进行双变量分析。然后，根据精神疾病合并症的状况将精神疾病队列进一步分为不同的亚队列：“急性”组为既往无精神疾病史、因新诊断或疑似精神疾病需要住院精神科会诊的患者；“稳定”组为有既往精神病史但不需要住院精神科会诊的患者；“慢性”组为有既往精神病史且需要持续住院精神科会诊的患者。比较这些队列之间的基线人口统计学和住院费用数据。
在616名符合纳入标准的患者中，94名患者（15.3%）患有既往精神疾病、在住院期间需要精神科会诊，或既患有既往精神疾病又在住院期间需要精神科会诊。精神疾病队列产生的住院总费用显著高于对照组（中位数费用：分别为22000欧元和15200欧元（p<0.01））。特别是，急性精神疾病队列产生的医院费用最高（住院总费用中位数为47000欧元）。多变量回归分析未显示精神疾病合并症是住院费用较高的独立预测因素（p=0.88）。相反，住院时间（p<0.01）、ISS（p<0.01）和总手术干预次数（p<0.01）独立预测住院总费用较高。
虽然有精神疾病合并症的多发伤患者的住院费用较高，但精神疾病合并症并不是多发伤患者住院费用增加的独立预测因素。相反，住院费用较高是由于有精神疾病合并症的患者住院时间更长、ISS更高以及手术干预次数更多。
