基于分位数回归模型的手术部位感染对骨科患者住院费用影响的探讨

Exploring the Influence of Surgical Site Infection on Hospitalization Expenses of Orthopedic Patients Based on Quantile Regression Model

目的探讨骨科术后患者住院费用影响因素,为预防手术部位感染、降低患者经济负担提供循证学依据。方法采取病例对照研究的方法,收集2019年1月1日-2022年12月31日骨科手术患者信息25452例,根据是否发生手术部位感染分为SSI组与对照组,比较2组患者住院时间及住院费用,建立分位数回归模型分析骨科手术住院费用的影响因素。结果SSI组较对照组住院时间长17天(Z=9.301,P<0.001),总住院费用高36333.15元(Z=4.312,P<0.001),其中手术用一次性医用材料费、其他费用、药品费用增加最多。年龄、慢性病患病状况、付费方式、SSI及手术部位是重要的住院费用影响因素;中低医疗费用支出水平下,高龄、患有糖尿病和高血压、自费付费、脊柱及关节部位对手术患者住院费用有显著影响;中高医疗费用支出水平下,SSI对患者住院费用有显著影响(P50,t=2.069,P=0.039;P75,t=22.550,P<0.001;P95,t=3.694,P<0.001)。结论各影响因素在不同分位点上对增加住院费用存在不同程度风险,SSI是主要危险因素,应采取针对性防控措施以降低感染风险,有助于降低患者住院费用。

Objectives This study aims to explore the influencing factors of hospital expenses for orthopedic patients after surgery and provide an evidence-based basis for preventing surgical site infections and reducing patients'economic burden.Methods A case-control study was conducted to collect information on 25,452 patients undergoing orthopedic surgery from January 1,2019 to December 31,2022.The patients were divided into an SSI group and a control group according to whether there was surgical site infection.The length of stay and hospital costs of the patients in the two groups were compared,and the quantile regression model was established to explore the influencing factors of the hospitalization costs of orthopaedic surgery.Results The length of hospitalization in SSI group was 17 days longer than that in control group(Z=9.301,P<0.001).The total hospitalization cost was 36333.15 yuan higher(Z=4.312,P<0.001),among which the cost of disposable medical materials for surgery,other expenses,and drug expenses increased the most.Age,chronic disease status,payment method,SSI and surgical site were important influencing factors of hospitalization expenses.At medium and low medical expense levels,advanced age,diabetes and hypertension,out-of-pocket payment,and spine and joint locations had a significant impact on the hospitalization expenses of surgical patients.At the medium-high level of medical expenditure,SSI had significant influence on the hospitalization cost of surgical patients(P50,t=2.069,P=0.039;P75,t=22.550,P<0.001;P95,t=3.694,P<0.001).Conclusions Each influencing factor has different degrees of risk for increasing hospitalization costs at different subsites.SSI is the main risk factor,and targeted prevention and control measures should be taken to reduce the risk of infection and help reduce the hospitalization costs of patients.