Ersen Teoman, Özcan Özhan, Öncü Kıvanç, Gokhan Servan
Department of Emergency, Sinop Atatürk State Hospital, Sinop, TUR.
Department of Critical Care Medicine, Ege University Faculty of Medicine, Izmir, TUR.
Cureus. 2025 Apr 25;17(4):e82966. doi: 10.7759/cureus.82966. eCollection 2025 Apr.
Introduction This study aimed to analyze the costs of emergency department (ED) visits among patients aged 65 years and older, with a particular focus on the financial burden of recurrent admissions within a one-year period. Methods A retrospective cross-sectional study was conducted on 143,909 ED visits recorded between January 1, 2014, and December 31, 2014, at the Emergency Department of Ankara Atatürk Training and Research Hospital, Ankara, Turkey. Data for patients aged 65 and older were extracted from the Hospital Information Management System. Cost data were based on the Social Security Institution billing system and converted into US dollars (USD) using the 2014 exchange rate. Patients were categorized by age, gender, diagnosis, and visit frequency. Nonparametric statistical tests were used due to the non-normal distribution of cost variables. A p-value < 0.05 was considered statistically significant. Results A total of 21,458 (15.0%) ED visits were made by patients aged 65 and older. The median cost per visit in this group was $58.16. Costs increased with age: $42.90 for patients aged 65-74, $76.67 for those aged 75-84, and $96.42 for those aged ≥85 (Kruskal-Wallis H = 1,125.3, df = 2, p < 0.001). Among the 19,159 elderly patients who visited the ED, 1,951 (10.2%) had recurrent visits. Within this subgroup, internal medicine diagnoses were most common (1,345 visits, or 68.9%), followed by pulmonary (320, or 16.4%), cardiovascular (211, or 10.8%), and non-specific complaints (231, or 11.8%) as the leading causes. This diagnostic distribution differed significantly from that of single-visit patients (χ² = 42.7, df = 3, p < 0.001). Recurrence rates varied significantly by diagnostic category (χ² = 89.4, df = 5, p < 0.001): the highest recurrence was observed in patients with hematologic conditions (56/355, or 15.8%; adjusted OR = 1.72, 95% CI: 1.28-2.31), followed by psychiatric (8/57, or 14.0%; adjusted OR = 1.45, 95% CI: 0.99-2.12) and pulmonary diagnoses (320/2,358, or 13.6%; adjusted OR = 1.38, 95% CI: 1.22-1.57), all above the overall recurrence rate of 10.2%. The median cost of the first ED visit was significantly higher in the recurrent group ($72.13) compared to the non-recurrent group ($59.76) (Mann-Whitney U = 14.2 × 10⁶, p < 0.001, r = 0.14). Among recurrent cases, the mean cost of the first visit ($101.84) exceeded the average cost of subsequent visits ($93.98) (Wilcoxon T = 2.4 × 10⁵, p < 0.001, r = 0.09). Conclusion Older patients generate disproportionately higher ED costs in Turkey, particularly those with recurrent visits and chronic conditions. These findings support the implementation of geriatric-focused emergency care models and preventive strategies to optimize resource utilization in aging populations.
引言 本研究旨在分析65岁及以上患者的急诊科就诊费用，特别关注一年内再次入院的经济负担。方法 对2014年1月1日至2014年12月31日期间土耳其安卡拉阿塔图尔克培训与研究医院急诊科记录的143,909次就诊进行回顾性横断面研究。65岁及以上患者的数据从医院信息管理系统中提取。费用数据基于社会保障机构计费系统，并使用2014年汇率换算成美元（USD）。患者按年龄、性别、诊断和就诊频率进行分类。由于费用变量呈非正态分布，因此使用非参数统计检验。p值<0.05被认为具有统计学意义。结果 65岁及以上患者共进行了21,458次（15.0%）急诊科就诊。该组每次就诊的中位数费用为58.16美元。费用随年龄增加而增加：65 - 74岁患者为42.90美元，75 - 84岁患者为76.67美元，85岁及以上患者为96.42美元（Kruskal - Wallis H = 1,125.3，自由度 = 2，p < 0.001）。在19,159名就诊的老年患者中，1,951名（10.2%）有再次就诊情况。在这个亚组中，内科诊断最为常见（1,345次就诊，占68.9%），其次是肺部疾病（320次，占16.4%）、心血管疾病（211次，占10.8%）和非特异性主诉（231次，占11.8%）为主要原因。这种诊断分布与单次就诊患者有显著差异（χ² = 42.7，自由度 = 3，p < 0.001）。复发率因诊断类别而异（χ² = 89.4，自由度 = 5，p < 0.001）：血液系统疾病患者的复发率最高（56/355，占15.8%；调整后OR = 1.72，95%CI：1.28 - 2.31），其次是精神疾病（8/57，占14.0%；调整后OR = 1.45，95%CI：0.99 - 2.12）和肺部诊断（320/2,358，占13.6%；调整后OR = 1.38，95%CI：1.22 - 1.57），均高于总体复发率10.2%。再次就诊组首次急诊科就诊的中位数费用（72.13美元）显著高于非再次就诊组（59.76美元）（Mann - Whitney U = 14.2×10⁶，p < 0.001，r = 0.14）。在再次就诊病例中，首次就诊的平均费用（101.84美元）超过后续就诊的平均费用（93.98美元）（Wilcoxon T = 2.4×10⁵，p < 0.001，r = 0.09）。结论 在土耳其，老年患者产生的急诊科费用过高，尤其是那些有再次就诊和慢性病的患者。这些发现支持实施以老年患者为重点的急诊护理模式和预防策略，以优化老年人群的资源利用。
