食道闭锁修复术患者的医疗费用:主要受相关畸形的影响

IF 1.5 3区 医学 Q2 PEDIATRICS European Journal of Pediatric Surgery Pub Date : 2024-10-29 DOI:10.1055/a-2422-3247
Nicolas Pardey, Jan Zeidler, Jochen Blaser, Nastassja Becker, Jens Dingemann, Benno Ure, Nagoud Schukfeh
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引用次数: 0

摘要

背景:食道闭锁(EA)是一种罕见疾病,通常需要在患者出生后几天内进行手术修复。食道闭锁患者需要密集的术后护理,而且往往合并其他疾病。目前还缺乏有关 EA 患者在出生后第一年所产生费用的数据:方法:Techniker Krankenkasse(客户人数在 1080 万左右)提供了匿名索赔数据。我们提取了在首次住院期间被诊断为 EA(ICD:Q39.0 或 Q39.1)和在食道闭锁的情况下进行食道重建(OPS 5-428.0 至 5-428.7、5-316.1 或 5-431.0)的患者的数据。所有患者首次住院时均为出生后第一年(2016-2020 年),并随访一年。采用描述性统计方法对费用、住院时间、机械通气持续时间和不同的 OPS 服务进行了分析。采用多元线性回归分析住院费用的决定因素:共纳入 119 名 EA 患者(55.5% 为男性)。一年观察期的平均费用为 89,736 欧元±97,419 欧元(范围为 12,755 欧元-640,154 欧元)。初次住院费用的增加导致一年观察期费用的不成比例增长。与无畸形和无并发症的患者相比,伴有畸形并伴有手术并发症的患者的费用几乎高出五倍(193,103€±157,507€ vs 39,846€±33,473€)。机械通气的平均持续时间为(23.2±43.1)天,平均住院时间为(80.3±77.2)天:据我们所知,这是第一项调查 EA 患者出生后第一年费用的研究。与没有伴发畸形且病程不复杂的患者相比,伴发畸形并伴有手术并发症的患者所需的费用几乎高出5倍。
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Medical Costs of Patients Undergoing Esophageal Atresia Repair are Mainly Influenced by Associated Malformations.

Background:  Esophageal atresia (EA) is a rare disease requiring surgical repair, usually within the first days of life. Patients with EA require intensive postoperative care and often have comorbidities. There is a lack of data on the costs incurred by patients with EA during the first year of life.

Methods:  Anonymized claims data were provided by the Techniker Krankenkasse (∼10.8 million clients). Data were extracted for patients who had an inpatient diagnosis of EA (International Classification of Diseases [ICD]: Q39.0 or Q39.1) and a reconstruction of the esophageal passage in case of atresia (Operationen-und Prozedurenschlüssel [German version of ICPM, International Classification of Procedures in Medicine; OPS] 5-428.0 to 5-428.7, 5-316.1 or 5-431.0) during their first hospital stay. All patients were in their first year of life at initial hospitalization (2016-2020) and were followed up for 1 year. Costs, length of hospital stay, and duration of mechanical ventilation and differentiated OPS services were analyzed using descriptive statistics. Multiple linear regression was used to analyze the determinants of hospital costs.

Results:  A total of 119 patients with EA were included (55.5% male). The mean cost of the 1-year observation period was €89,736 ± 97,419 (range €12,755-640,154). The increasing costs of the initial hospitalization led to a disproportionate increase in the costs of the 1-year observation period. The presence of an associated malformation combined with surgical complications was associated with almost five-fold higher costs than in patients without an associated malformation and an uncomplicated course (€193,103 ± 157,507 vs. €39,846 ± 33,473). The mean duration of mechanical ventilation was 23.2 ± 43.1 days and the mean length of hospital stay was 80.3 ± 77.2 days.

Conclusion:  To our knowledge, this is the first study to investigate the costs of EA patients in the first year of life. The presence of an associated malformation combined with surgical complications was associated with almost five-fold higher costs than in patients without an associated malformation and an uncomplicated course.

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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
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