Cost-effectiveness and clinical outcomes comparison between noninvasive ventilation and high-flow nasal cannula use in patients with multiple rib fractures.
Junsik Kwon, Timothy Allison-Aipa, Thomas Patton, Bishoy Zakhary, Bruno C Coimbra, Matthew Firek, Raul Coimbra
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引用次数: 0
Abstract
Background: Patients with multiple rib fractures often require advanced respiratory support to prevent intubation and associated morbidity. Noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) are commonly used, but direct comparisons of clinical outcomes and cost-effectiveness remain limited. This study aimed to compare NIV versus HFNC using a large, nationwide US database.
Methods: This retrospective cohort study used the 2020-2021 National Inpatient Sample database to identify adult trauma patients (18-89 years) with two or more rib fractures who received either NIV or HFNC without prior intubation. To focus on isolated thoracic injuries, patients with significant injuries elsewhere (Abbreviated Injury Scale score ≥3) or who died within 24 hours were excluded. Inverse probability of treatment of weighting was used to balance patient characteristics, including demographics, comorbidities, and injury severity. Primary outcomes included mortality, tracheostomy, pulmonary complications, and intubation rates. Hospital length of stay and total costs were also assessed. Cost-effectiveness analyses were conducted with intubation avoidance as the effectiveness measure, and a willingness-to-pay threshold of US $50,000 per effectiveness unit was used.
Results: After adjustment, the NIV group demonstrated significantly better outcomes compared with HFNC, including lower mortality (11.4% vs. 17.0%, p = 0.007) and tracheostomy (1.2% vs. 3.1%, p = 0.006), and fewer pulmonary complications. Although intubation rates were not statistically different (12.0% vs. 15.6%, p = 0.085), the HFNC group had longer length of stay (13 vs. 10 days, p < 0.001) and incurred higher costs (US $42,505 vs. US $32,024, p < 0.001). Cost-effectiveness analysis revealed that NIV dominated HFNC, yielding better outcomes at lower costs.
Conclusion: Among patients with multiple rib fractures, NIV yielded superior clinical outcomes, shortened hospital stays, and reduced costs compared with HFNC. These findings suggest that NIV may be a more cost-effective and clinically advantageous choice.
Level of evidence: Therapeutic/Care Management; Level III.
背景：多发肋骨骨折患者通常需要先进的呼吸支持，以防止插管和相关的发病率。无创通气（NIV）和高流量鼻插管（HFNC）常用，但临床结果和成本效益的直接比较仍然有限。这项研究的目的是通过一个大型的美国全国数据库来比较NIV和HFNC。方法：本回顾性队列研究使用2020-2021年国家住院患者样本数据库，识别两次或两次以上肋骨骨折的成人创伤患者（18-89岁），这些患者在没有事先插管的情况下接受了NIV或HFNC。为了关注孤立性胸部损伤，我们排除了其他部位有明显损伤（简略损伤量表评分≥3）或24小时内死亡的患者。使用加权治疗的逆概率来平衡患者特征，包括人口统计学、合并症和损伤严重程度。主要结局包括死亡率、气管切开术、肺部并发症和插管率。还评估了住院时间和总费用。成本效益分析以避免插管作为有效性衡量标准，并采用每个有效性单位5万美元的支付意愿阈值。结果：调整后，NIV组的预后明显优于HFNC组，死亡率（11.4% vs. 17.0%, p = 0.007）和气管造口术（1.2% vs. 3.1%, p = 0.006）较低，肺部并发症较少。虽然插管率无统计学差异（12.0%对15.6%,p = 0.085），但HFNC组的住院时间更长（13天对10天，p < 0.001），费用更高（42,505美元对32,024美元，p < 0.001）。成本效益分析显示，NIV在HFNC中占主导地位，以更低的成本获得更好的结果。结论：在多发肋骨骨折患者中，与HFNC相比，NIV具有更好的临床效果，缩短了住院时间，降低了费用。这些发现表明，无创通气可能是一种更具成本效益和临床优势的选择。证据水平：治疗/护理管理；第三层次。
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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