术前贫血对心脏瓣膜置换术术后医院感染的影响及经济负担

Influence of preoperative anemia on postoperative nosocomial infection in heart valve replacement patients and economic burden

目的通过分析心脏瓣膜置换术患者术前贫血对医院感染的影响以及其直接和间接经济负担,为临床防控措施的制定提供经济学依据。方法收集2018年1月1日-2019年12月31日在山东某三级甲等医院接受心脏瓣膜置换术的720例心脏瓣膜病患者的人口学资料、临床和实验室数据。分析心脏瓣膜置换术患者术后发生医院感染的危险因素,并采用1∶1病例对照匹配分析患者的经济负担以及住院时间。结果纳入符合标准的患者720例,术后发生医院感染151例,感染率20.97%;Logistic回归分析结果显示,年龄、术前贫血、留置胃管、美国麻醉医师协会(ASA)分级、左室射血分数是术后感染的独立危险因素(P<0.05);共匹配成功23组,医院感染组住院总费用是210525.35元,非医院感染组是157383.18元,总的直接经济负担是71414.05元(Z=-3.746,P<0.001);感染组各费用均高于非感染组,其中以西药费差值最大,总的经济负担是40708.36元(Z=-4.932,P<0.001);医院感染组住院时间是35天,非医院感染组是23天,延长住院时间12天,对患者造成的间接经济负担为6409.93元。结论术前贫血增加了心脏瓣膜病患者术后发生医院感染的风险,而医院感染的发生增加了患者的医疗费用,延长了患者的住院时间,因此在可行的情况下,改善贫血对于促进良性结局具有重要意义。

OBJECTIVE To analyze the effect of preoperative anemia on the nosocomial infection in patients undergoing heart valve replacement and its economic burden,to provide economic basis for the establishment of the clinical prevention and control measures.METHODS The demographic data,clinical and laboratory data of the 720 patients undergoing heart valve replacement of heart valve disease in a three-A tertiary hospital from Jan 1,2018 to Dec 31,2019 were collected.The risk factors for postoperative nosocomial infection of the patients with cardiac valve replacement were analyzed.RESULTS A total of 720 patients who met the criteria were included in the study.Postoperative nosocomial infection occurred in 151 cases,with an infection rate of 20.97%.Logistic regression analysis showed that age,preoperative anemia,indwelling gastric tube,ASA stage,left heart ejection fraction were independent risk factors for postoperative infection(P<0.05).Twenty-three pairs of groups were matched:hospitalization cost in the nosocomial infection group was 210525.35 yuan,and that in the non-nosocomial infection group was 157383.18 yuan;the total direct economic burden was 71414.05 yuan(Z=-3.746,P<0.001),the difference between western medicine was the largest,the overall economic burden was 40708.36 yuan(Z=-4.932,P<0.001).Hospital stay in the hospital infection group was 35 days,and that in the non-nosocomial infection group was 23 days,which indicated that the length of hospital stay of the patients extended by 12 days due to the nosocomial infections,leading to the indirect economic burden of 6409.93 yuan to patients.CONCLUSION Preoperative anemia increases the risk of heart valve disease postoperative nosocomial infection,which leads to the increase of medical cost and the length of hospital stay.So in a proper condition,treating anemia can promote the benign outcome.