基于DRGs病例组合指数和相对权重的胸外科ICU医院感染研究

Healthcare-associated infection in a thoracic surgery ICU based on case mix index and relative weight of diagnosis-related groups

摘要:

目的 探讨胸外科重症监护病房(ICU)患者医院感染与疾病诊断相关分组(DRGs)中部分指标的关系。 方法 回顾性分析2022年1—12月上海市某三级专科医院胸外科ICU及肺外科组、食管外科组、纵膈组(胸腺手术为主)、气管组4个亚专科病例的DRGs分组情况、病例组合指数(CMI)、相对权重(RW)以及患者的医院感染情况, 并通过DRGs指标分组比较。 结果 共纳入1 429例胸外科ICU患者, 发生医院感染59例, 医院感染发生率为4.13%。肺外科组、食管外科组、纵膈组、气管组患者医院感染发生率分别为3.74%(30/803)、5.84%(25/428)、1.27%(2/157)、4.88%(2/41), 各亚专科组医院感染发生率比较, 差异无统计学意义(P＞0.05);共涉及DRGs组数35个, 肺外科组、食管外科组、纵膈组、气管组CMI分别为2.75, 3.41, 2.35、1.25, RW为0.53~12.62。肺外科组患者中男性医院感染发生率较女性高; RW分值级别越高, 其医院感染发生率越高; 差异均有统计学意义(均P＜0.05)。食管外科组患者中医院感染组年龄高于非医院感染组(P＜0.05);RW分值级别越高, 其医院感染发生率越高(P＜0.05);纵膈组中感染组患者年龄较非感染组高(P＜0.05)。59例医院感染病例中, 31例为MDRO感染。 结论 聚焦DRGs指标体系中CMI和RW, 从收治疾病的疑难复杂程度和医疗服务的整体技术难度的角度来分析医院感染, 可为新时期精准化医院感染管理模式提供参考。

Abstract:

Objective To explore the correlation between healthcare-associated infection (HAI) and partial indexes in the diagnosis-related groups (DRGs) of patients in thoracic surgery intensive care unit (ICU). Methods DRGs, case mix index (CMI), relative weight (RW), and HAI of patients in thoracic surgery ICU and four subspecialty departments (pulmonary surgery group, esophageal surgery group, mediastinum group [mainly thymic surgery], and trachea group) in a tertiary chest hospital in Shanghai from January to December 2022 were retrospectively analyzed and compared through DRGs index grouping. Results A total of 1 429 patients in the department of thoracic surgery ICU were analyzed, including 59 HAI cases, with a HAI rate of 4.13%. The incidences of HAI in pulmonary surgery group, esophageal surgery group, mediastinum group and trachea group were 3.74% (30/803), 5.84% (25/428), 1.27% (2/157) and 4.88% (2/41), respectively. There was no statistically significant difference in the incidences of HAI among different subspecialty groups (P>0.05). A total of 35 DRGs were involved, with CMI of 2.75, 3.41, 2.35 and 1.25 in pulmonary surgery group, esophageal surgery group, mediastinum group and trachea group, respectively, and RW ranged from 0.53 to 12.62. In the pulmonary surgery group, incidence of HAI in male patients was higher than that in female patients. Higher RW score level was associated with higher incidence of HAI. Differences were all statistically significant (all P < 0.05). Among patients in the esophageal surgery group, the age of HAI group was higher than that of the non-HAI group (P < 0.05). Higher RW score level was associated with higher incidence of HAI (P < 0.05). Among patients in the mediastinum surgery group, the age of patients in the infected group was higher than that in the non-infected group (P < 0.05). Among the 59 HAI cases, 31 were infected with MDROs. Conclusion Focusing on CMI and RW in the DRGs index system, analyzing HAI from the perspectives of disease complexity and overall technical difficulties of medical services can provide reference for the precise management of HAI in the new era.