根治性胰十二指肠切除术患者医院感染直接经济负担

Direct economic burden of healthcare-associated infections in patients undergoing radical pancreatoduodenectomy

摘要:

目的 调查根治性胰十二指肠切除术患者医院感染的发病率,评估此类患者因医院感染导致的经济负担,为感染防控提供卫生经济学支持。方法 回顾性收集山东省某三级甲等教学医院普通外科某病区2020年1月—2022年12月收治的进行根治性胰十二指肠切除术患者的临床资料,并调查手术患者医院感染情况。根据患者手术后是否发生医院感染分为感染组和非感染组,采用1 ∶1 倾向性评分匹配法构建协变量均衡数据库,比较两组患者的住院费用和住院日数,计算医院感染造成的经济负担。结果 共纳入287例根治性胰十二指肠切除术患者,其中35例发生医院感染,医院感染发病率为12.20%。倾向性评分匹配法共匹配成功33对。 匹配后,感染组与非感染组患者的住院总费用中位数分别为120 722.0、100 367.0元,感染组多支出住院总费用20 355.0元(P<0.05); 中位住院时间分别为28、19 d,感染组延长住院时间9 d(P<0.05)。对两组患者的各单项费用进行分析,结果显示除手术费和卫生材料费外,感染组各项医疗支出均高于非感染组(均P<0.05),其中西药费导致的经济负担最大,达11 427.0元,其次分别是治疗费(3 228.0元)、检查费(2 304.0元)。除手术费与卫生材料费外,感染组各项费用构成比均增加,其中西药费增幅最大,达2.66%。结论 根治性胰十二指肠切除术患者医院感染会增加住院费用,延长住院时间,预防术后医院感染的发生有利于减轻患者及医院的经济负担。

Abstract:

Objective To investigate the incidence of healthcare-associated infection (HAI) in patients undergoing radical pancreatoduodenectomy (RPD), assess the economic burden caused by HAIs in these patients, and provide health and economic support for infection prevention and control. Methods Clinical data of patients who underwent RPD in a general surgery ward of a tertiary teaching hospital in Shandong Province from January 2020 to December 2022 were collected retrospectively. The incidences of HAIs in these patients were investigated. Patients were divided into the infection group and the non-infection group based on whether they developed postoperative HAI. A 1 ∶1 propensity score matching method was adopted to construct a covariate balanced database. The hospitalization expenses and length of hospital stay were compared between the two groups of patients, and the economic burden caused by HAIs was calculated. Results A total of 287 patients undergoing RPD were included in the analysis, of whom 35 developed HAI, with a HAI incidence of 12.20%. Propensity score matching method successfully matched 33 pairs. After matching, the median total hospitalization expenses for patients in the infection and non-infection groups were 120 722.0 Yuan and 100 367.0 Yuan, respectively, with the infection group incurring an additional total hospitalization expenses of 20 355.0 Yuan (P<0.05); the median length of hospital stay were 28 and 19 days, respectively, and the infection group had an extended length of hospital stay of 9 days (P<0.05). The analysis of individual costs for the two groups showed that, except for the expenses of surgical costs and hygiene mate-rials costs, all other medical expenditures were significantly higher in the infection group than in the non-infection group (all P<0.05). The economic burden caused by Western medicine costs was the highest, reaching 11 427.0 Yuan, followed by treatment costs (3 228.0 Yuan) and examination costs (2 304.0 Yuan). Except for the expenses of surgery and hygiene material costs, the constituent ratio of all other costs increased in the infection group, with the largest increase being in Western medicine costs, which rose by 2.66 %. Conclusion HAIs in patients under-going RPD can increase hospitalization expenses and prolong length of hospital stay. Prevention of postoperative HAIs is beneficial for reducing the economic burden on patients and hospitals.