老年患者术前主要心血管不良事件风险评估与医疗费用的相关性

The correlation between preoperative risk assessment of major adverse cardiovascular events and costs in elderly patients

目的分析老年患者术前主要心血管不良事件(MACEs)风险评估与围术期麻醉费用及住院总费用的相关性,探讨优化医疗保险支付制度的新路径。方法前瞻性选择2020年1—12月本院行全身麻醉下手术的老年患者5642例,男3152例,女2490例,年龄≥65岁,BMI 16~36 kg/m^(2),ASAⅠ—Ⅳ级。所有患者术前进行术后MACEs的标准化评估,根据术前评估结果将患者分为三组:低危组(n=4520)、中危组(n=743)和高危组(n=379),比较不同危险层级患者术后MACEs的发生情况及医疗费用差异。结果本研究共纳入老年患者5642例,术后30 d MACEs发生率为154例(2.73%),其中,低危组39例(0.86%),中危组55例(7.40%),高危组60例(15.83%)。与低危组比较,中危组和高危组麻醉费用、住院费用明显增加(P<0.001),住院时间明显延长(P<0.001)。与中危组比较,高危组麻醉费用、住院费用明显增加(P<0.001),住院时间明显延长(P<0.001)。骨科手术中,中危组和高危组麻醉费用明显高于低危组(P<0.05),住院时间明显长于低危组(P<0.05)。心脏手术中,高危组住院时间明显长于中危组(P<0.05)。结论术前评估可有效预测术后MACEs的发生风险和患者医疗费用支出,可为优化外科患者医保分组付费提供依据。

Objective To analyze the relationship between preoperative risk assessment of major cardiovascular adverse events(MACEs)and perioperative anesthesia costs and hospitalization costs in elderly patients,and to explore a new path to optimize the medical insurance payment system.Methods A total of 5642 elderly patients who underwent general anesthesia from January 2020 to December 2020 were prospectively enrolled for standardized preoperative evaluation of postoperative MACEs,3152 males and 2490 females,aged≥65 years,BMI 16-36 kg/m^(2),ASA physical statusⅠ-Ⅳ,were divided into three groups:low-risk group(n=4520),medium-risk group(n=743),and high-risk group(n=379)according to preoperative evaluation rules.The incidence of postoperative MACEs and the differences in medical insurance costs among patients with different risk levels were compared.Results A total of 5642 elderly patients were included,and 154 patients(2.73%)developed MACEs after surgery,including 39 patients in the low-risk group(0.86%),55 patients in the medium-risk group(7.40%),and 60 patients in the high-risk group(15.83%).Compared with low-risk group,the anesthesia cost and hospitalization cost were significantly higher in medium and high-risk group(P<0.001),and the duration of hospitalization was markedly longer in medium and high-risk group(P<0.001).Compared with the medium-risk group,the anesthesia cost and hospitalization cost were significantly higher(P<0.001)in the high-risk group,and the duration of hospitalization was significantly longer(P<0.001).Compared with low-risk group,the anesthesia cost of orthopedic surgery in medium-risk group and high-risk group were significantly higher(P<0.05),and the duration of hospitalization of orthopedic surgery in medium-risk group and high-risk group were significantly longer(P<0.05).Compared with medium-risk group,the duration of hospitalization of cardiac surgery in high-risk group was significantly longer(P<0.05).Conclusion Preoperative evaluation can effectively predict the risk of postoperative MACEs and the level of medical expenses of patients,which can provide a basis for optimizing medical insurance group payment for surgical patients.