脑动脉瘤手术患者医院感染经济负担

Economic burden of hospital-acquired infection in patients undergoing cerebral aneurysms surgery

目的探讨脑动脉瘤手术患者医院感染经济负担。方法收集2020年7月1日-2023年6月30日在山东省某三甲医院神经外科行脑动脉瘤手术的668例患者的病历资料,采用倾向性评分法,将54例医院感染患者与614例未感染患者进行1∶1配对后比较两组患者在住院日数及住院费用方面的差异。结果两组患者动脉瘤位置多在脑前循环,手术多为介入引导下的脑动脉瘤栓塞术,付费方式多为城镇居民医保支付;医院感染发病率为8.08%(54/668),以颅内感染及呼吸道感染为主;共匹配成功51对患者,分别纳入感染组与对照组,感染组与对照组的住院日数中位数分别为26天和15天,住院总费用分别为14.49万元、11.14万元,差异具有统计学意义(P<0.001);单项费用方面,感染组床位费、诊疗费、检查费、治疗费、护理费、化验费、手术费、西药费等项目均有不同程度的增加(P<0.05);Ridge分析显示住院天数、床位费、诊疗费、治疗费、护理费、化验费、手术费、西药费是增加住院总费用的重要影响因素(P<0.05)。结论脑动脉瘤手术患者发生医院感染后将延长住院时间、增加住院费用,采用倾向性评分匹配方法可为经济负担研究提供更为准确的统计结果,落实有效的医院感染防控措施对于减少经济负担、提高医疗质量具有重要意义。

OBJECTIVE To explore the economic burden of hospital-acquired infections in patients undergoing cere-bral aneurysm surgery.METHOD The medical records of 668 patients who underwent cerebral aneurysm surgery at the department of neurosurgery of a tertiary first-class comprehensive hospital in Shandong Province from Jul.12020 to Jun.302023 were collected,and the differences in length of hospital stay and hospitalization costs between two groups of matched patients were compared using the propensity score method after paring 54 patients with hospital-acquired infection with 614 uninfected patients in a 1:1 match.RESULTS The location of aneurysms in both groups mostly in the anterior circulation,and the procedures were mostly interventional-guided embolization of cerebral aneurysms.The payment methods were mostly paid by urban residents'health insurance.The incidence of hospital-acquired infection was 8.08%(54/668),with intracranial infection and respiratory tract infection pre-dominating.A total of 51 pairs of patients were successfully matched divided into infection group and control group.The median number of hospitalization day in the infection group and control group was 26 days and 15 days respectively,and the total hospitalization cost was 144,900 yuan and 111,400 yuan respectively.The difference of the total hospitaization cost between two groups was statistically significant(P<0.001).In terms of individual costs,the items of bed fee,diagnosis fee,inspection fee,treatment fee,nursing fee,operation fee,and medicine fee in the infection group increased to different degrees(P<0.05).Multivariate regression analysis showed that the number of hospitalization days,bed fee,diagnosis fee,treatment fee,nursing fee,laboratory fee,operation fee and medicine fee were the important influencing factors that increased the total hospitalization cost(P<0.05).CONCLUSIONS The occurrence of hospital-acquired infections in patients undergoing cerebral aneurysm surgery would prolong the length of hospitalization and increase the cost of hospitalization.The use of propensity score matching method can provide more accurate results for economic burden research,and the implementation of effective hospital-acquired infection prevention and control measures is of great significance for the reduction of economic burden and for the improvement of the quality of medical care.