股骨转子间骨折内固定治疗住院总费用的影响因素研究

Total cost of hospitalization after internal fixation of intertrochanteric fracture

目的探讨内固定治疗股骨转子间骨折患者住院总费用的影响因素。方法回顾性分析2013年3月至2014年8月收治的142例股骨转子间骨折患者资料，男54例，女88例；年龄为24-95岁，平均69．8岁。135例采用髓内固定，7例采用髓外固定。骨折AO分型：3I-AI型32例，31-A2型75例，31-A3型35例。收集内容包括基本影响因素、骨折相关因素、失血量相关因素和手术相关因素。单因素变量分析中，两组间比较采用两独立样本t检验，多组间比较采用单因素方差分析。多因素分析采用多元线性回归分析，应用逐步法对变量进行分析，P〈0．05认为差异有统计学意义。结果术前存在下肢深静脉血栓形成的患者住院总费用平均为（6．9±1．0）万元，显著高于无血栓形成患者【（5．0±0．8）万元】；髓内固定患者住院总费用[（5．5±1．2）万元]显著高于髓外固定患者【（4．4±0．7）万元】，以上项目比较差异均有统计学意义（P〈0．05）。多因素线性回归分析结果显示：术前是否存在下肢深静脉血栓形成（t=11．750，P〈0．001）、围手术期是否输血（t=2．803，P=0．006）、住院时间（t=5．949，P〈0．001）和术中失血量（t=2．885，P=0．005）是影响住院总费用的相关因素。结论术前存在下肢深静脉血栓形成、围手术期接受异体输血、术中失血量增加和住院时间延长会提高内固定治疗股骨转子间骨折患者的住院总费用。在确保患者围手术期安全的前提下，应适当控制增加住院总费用的相关因素。

Objective To analyze the factors influencing the total cost of hospitalization after in- ternal fixation of intertrochanteric fracture. Methods Enrolled in this study were 142 patients with in- tertrochanteric fracture who had been treated at our department between March 2013 and August 2014. They were 54 men and 88 women, aged from 24 to 95 years （average 69. 8 years）. Intramedullary fixation was adopted in 135 cases while extramedullary fixation in 7. By AO classification, 32 cases were type A1, 75 type A2 and 35 type A3. We analyzed their demographic data, fracture-associated factors, bleeding-associated factors and surgery-associated factors. For univariate analysis, the independent sample t test was performed between 2 groups. One-Way ANOVA analysis was performed among several groups. For multivariate analysis, multivariate linear regression analysis was performed. P 〈 0. 05 was regarded as statistically significant. Results The independent sample test revealed that the total cost of hospitalization for those with preoperative deep venous thrombosis （6. 9 ± 1.0 × 10^5 ￥） was significantly higher than for those without （5.0 ±0. 8 × 10^5 ￥） and the total cost for those undergoing intramedullary fixation （5.5 ±1.2 × 10^5 ￥） was significantly higher than for those undergoing extramedutlary fixation （4.4 ±0. 7 × 10^5 ￥） （ P 〈 0. 05）. The multiple linear re- gression analyses showed that preoperative deep venous thrombosis （ t = 11. 750, P 〈 0. 001）, perioperative transfusion （ t = 2. 803, P = 0. 006）, hospital stay （ t = 5. 949, P 〈 0. 001） and intraoperative blood loss （ t = 2. 885, P = 0. 005） were the independent factors influencing the total cost of hospitalization. Conclusions Preoperative deep venous thrombosis, perioperative transfusion, intraoperative blood loss, and hospital stay may influence the total cost of hospitalization for patients undergoing internal fixation of in- tertrochanteric fracture. More attention should be paid to control of the total cost of hospitalization in addition to ensuring the perioperative life safety.