广州市1808例骨质疏松脊柱骨折多中心住院患者医疗资源分析

A multiple centers report of osteoporotic vertebral fractures: 5 years(2003-2007) review of the hospitalized prevalence and inpatient costs

目的回顾分析2003年1月至2007年12月5年广州地区老年脊柱骨折住院患者的基本情况与住院费用结构,了解老年骨折住院患者基本趋势及其所需要的医疗资源。方法 5年间,广州中医药大学第一、二附属医院、中山大学附属第二医院与广州医学院第三附属医院骨科共收治1 808例年龄≥50岁的脊柱骨折患者,其基本情况来源于医院病案信息管理系统。回顾分析患者的年龄结构、性别构成、住院时间与住院费用等。结果过去5年脊柱骨折的患者住院人数相对稳定,每年的女性患者人数均显著高于男性患者。男女患者总人数比为1∶2.35,男性占29.87%,女性占70.13%。患者最大年龄为105岁,平均(72.08±9.92)岁。平均住院时间(20.12±13.92)d,各个年龄段住院时间差异无统计学意义(P>0.05)。各个年龄段中,70～79岁年龄段的患者数最多(41.87%)。胸椎与腰椎骨折老年患者50～79岁年龄段随着年龄的增加患者而增加,80～岁以上随着年龄的增加而减少,胸腰椎骨折的比例为1∶1.38。患者的住院总费用平均为6 532.14(443.02,10 637.60)万元,胸腰椎骨折的住院费用比较差异无统计学意义(P>0.05),手术患者住院总费用为(3.30±2.83)万元,非手术患者(0.82±0.60)万元。住院总费用中,治疗费(含内置物等费用)占43.24%,药费占31.33%,其次为床位费8.16%,检查费5.5%,化验费4.75%,手术费2.89%。以50～59岁年龄段患者住院费用最高,并与年龄段的趋势相反。近5年来总住院费用逐年递增,平均每年增加23.97%,手术患者年增长率为18.93%,非手术患者年增长率为9.51%。结论脊柱骨折所需医疗费用逐年递增。女性患者占全部患者的2/3以上,而且60～69岁女性患者比例最高,绝经后骨质疏松及其骨折是防治工作的重点。有效控制内置物以及药费是减少脊柱骨折占用医疗资源,减轻患者与社会经济负担的有效途径。

Objective To analyze the hospitalized prevalence in the past 5 years （2003 -2007） and to estimate resource utilization associated with osteoporotic vertebral fractures, including hospital length of stay and inpatient costs in Guangzhou, China. Methods The data of 1 808 patients aged 50 years and older, who were hospitalized for primary di- agnosis of vertebral fractures in four hospitals in the past 5 years, were reviewed. Clinical parameters such as sex, hospital length of stay, inpatient costs, and the constitutions of the inpatient costs were analyzed. Results Over the 5 - year study, the number of hospitalizations for vertebral fractures was kept at the same level. The male to female ratio was about 1： 2. 35. Average age was （72. 08±9. 92） years old. Average hospital length of stay was （20. 12±13.92） days with no significant difference among genders, the different years, and the different diagnoses. The patients with age of 70 to 79 years accounted for the majority of the hospitalization （41.87%）. Between the age of 50 to 79 years the lumbar vertebral fracture was significantly more prevalent than thoracic fracture （P 〈 0.01 ） ; however, there was no significant difference in patients over 80 years old （ P 〉 0. 05 ）. The inpatient cost was （ 13.49 ±17.42 ） thousand Yuan （RMB） per patient, with no significant difference between the thoracic and lumbar vertebrae fractures （ P 〉 0. 05 ）. The inpatient cost for operative patient was （33.03 ±28. 26 ） thousand Yuan （RMB） per patient, and non - operative was （ 81.48±59. 69 ） thousand Yuan （RMB） per patient. The inpatient cost included 43.24% of treatment costs （ including implants, materials used in the theatre and routinely care of the wound）, 31.33% of pharmacy intervention, 2. 89% of operation, 8. 16% of ward ex- penditure, 5.5% of physical investigation, and 4. 75% of chemistry tests. The inpatient cost was negatively correlated with the age. The total inpatient cost was increased every year in the past 5 years by 23.97% , and by 18. 93% in opera- tive patient, while by 9. 51% in non - operative ones. Conclusion The growing economic impact is aroused from the in- patient treatment of osteoporotic spine fractures, most of which is correlated to treatment cost and pharmacy intervention. More attention should be paid to the vertebral fracture of menopausal women due to the large population. National datasets need to be further refined to ensure more accurate estimations of the cost of vertebral fractures in the China.