美国医院术后尿潴留的经济影响。

IF 2.3 Q2 ECONOMICS

Journal of Health Economics and Outcomes Research Pub Date : 2024-08-08 eCollection Date: 2024-01-01 DOI:10.36469/001c.121641

Weijia Wang, Arielle Marks-Anglin, Vladimir Turzhitsky, Robert J Mark, Aurelio Otero Rosales, Nathaniel W Bailey, Yiling Jiang, Joseph Abueg, Ira S Hofer, Toby N Weingarten

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Patients were divided into 2 groups: those experiencing POUR (composite of retention of urine, insertion of temporary indwelling bladder catheter, insertion of non-indwelling bladder catheter) during index hospitalization following surgery and those without POUR. Surgeries in inpatient and outpatient settings were analyzed separately. A cross-sectional comparison was performed to report total hospital charges for the 2 groups. Furthermore, patients experiencing subsequent POUR events within three days after discharge from index hospitalization were studied. Results: A total of 330 838 inpatients and 437 063 outpatients were included. POUR developed in 13 020 inpatients and 2756 outpatients. Unadjusted results showed that POUR was associated with greater charges in both inpatient ( <math><mn>92</mn> <mrow><mo> </mo></mrow> <mn>529</mn> <mi>w</mi> <mi>i</mi> <mi>t</mi> <mi>h</mi> <mi>P</mi> <mi>O</mi> <mi>U</mi> <mi>R</mi> <mi>v</mi> <mi>s</mi></math> 78 556 without POUR, p < .001) and outpatient ( <math><mn>48</mn> <mrow><mo> </mo></mrow> <mn>996</mn> <mi>w</mi> <mi>i</mi> <mi>t</mi> <mi>h</mi> <mi>P</mi> <mi>O</mi> <mi>U</mi> <mi>R</mi> <mi>v</mi> <mi>s</mi></math> 35 433 without POUR, p < .001) settings. After adjusting for confounders, POUR was found to be associated with greater charges with an overall mean adjusted difference of <math><mn>10</mn> <mrow><mo> </mo></mrow> <mn>668</mn> <mo>(</mo> <mn>95</mn></math> 95 760- <math><mn>11</mn> <mrow><mo> </mo></mrow> <mn>760</mn> <mo>,</mo> <mi>p</mi> <mrow><mo> </mo></mrow> <mo><</mo> <mrow><mo> </mo></mrow> <mn>.001</mn> <mo>)</mo> <mi>i</mi> <mi>n</mi> <mi>i</mi> <mi>n</mi> <mi>p</mi> <mi>a</mi> <mi>t</mi> <mi>i</mi> <mi>e</mi> <mi>n</mi> <mi>t</mi> <mi>a</mi> <mi>n</mi> <mi>d</mi></math> 13 160 (95% CI <math><mn>11</mn> <mrow><mo> </mo></mrow> <mn>750</mn> <mo>-</mo></math> 14  571, p < .001) in outpatient settings. Charges associated with subsequent POUR events following discharge ranged from <math><mn>9418</mn> <mi>i</mi> <mi>n</mi> <mi>p</mi> <mi>a</mi> <mi>t</mi> <mi>i</mi> <mi>e</mi> <mi>n</mi> <mi>t</mi> <mi>c</mi> <mi>h</mi> <mi>a</mi> <mi>r</mi> <mi>g</mi> <mi>e</mi> <mi>s</mi> <mi>t</mi> <mi>o</mi></math> 1694 outpatient charges. Conclusions: Surgical patients who were pharmacologically reversed for NMB and developed a POUR event incurred greater charges than patients without POUR. These findings support the use of NMB reversal agents associated with a lower incidence of POUR.","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"11 2","pages":"29-34"},"PeriodicalIF":2.3000,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392480/pdf/","citationCount":"0","resultStr":"{\"title\":\"Economic Impact of Postoperative Urinary Retention in the US Hospital Setting.\",\"authors\":\"Weijia Wang, Arielle Marks-Anglin, Vladimir Turzhitsky, Robert J Mark, Aurelio Otero Rosales, Nathaniel W Bailey, Yiling Jiang, Joseph Abueg, Ira S Hofer, Toby N Weingarten\",\"doi\":\"10.36469/001c.121641\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Postoperative urinary retention (POUR) is a common and distressing surgical complication that may be associated with the pharmacological reversal technique of neuromuscular blockade (NMB). 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Results: A total of 330 838 inpatients and 437 063 outpatients were included. POUR developed in 13 020 inpatients and 2756 outpatients. Unadjusted results showed that POUR was associated with greater charges in both inpatient ( <math><mn>92</mn> <mrow><mo> </mo></mrow> <mn>529</mn> <mi>w</mi> <mi>i</mi> <mi>t</mi> <mi>h</mi> <mi>P</mi> <mi>O</mi> <mi>U</mi> <mi>R</mi> <mi>v</mi> <mi>s</mi></math> 78 556 without POUR, p < .001) and outpatient ( <math><mn>48</mn> <mrow><mo> </mo></mrow> <mn>996</mn> <mi>w</mi> <mi>i</mi> <mi>t</mi> <mi>h</mi> <mi>P</mi> <mi>O</mi> <mi>U</mi> <mi>R</mi> <mi>v</mi> <mi>s</mi></math> 35 433 without POUR, p < .001) settings. 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Charges associated with subsequent POUR events following discharge ranged from <math><mn>9418</mn> <mi>i</mi> <mi>n</mi> <mi>p</mi> <mi>a</mi> <mi>t</mi> <mi>i</mi> <mi>e</mi> <mi>n</mi> <mi>t</mi> <mi>c</mi> <mi>h</mi> <mi>a</mi> <mi>r</mi> <mi>g</mi> <mi>e</mi> <mi>s</mi> <mi>t</mi> <mi>o</mi></math> 1694 outpatient charges. Conclusions: Surgical patients who were pharmacologically reversed for NMB and developed a POUR event incurred greater charges than patients without POUR. 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引用次数: 0

摘要

背景：术后尿潴留（POUR）是一种常见且令人痛苦的手术并发症，可能与神经肌肉阻断（NMB）的药物逆转技术有关。研究目的本研究旨在调查 POUR 对医疗费用的影响。方法：这是一项回顾性观察研究：这是一项回顾性观察研究，使用 PINC-AI™ 医疗保健数据库中的数据，对 2017 年 2 月至 2021 年 11 月期间接受特定手术、使用神经肌肉阻滞剂（NMBA）并进行药理逆转的成年患者进行观察。患者分为两组：术后指数住院期间出现 POUR（尿潴留、插入临时留置膀胱导尿管、插入非留置膀胱导尿管的复合情况）的患者和未出现 POUR 的患者。住院和门诊手术分别进行分析。通过横向比较，报告了两组患者的住院总费用。此外，还对指数住院出院后三天内发生后续 POUR 事件的患者进行了研究。研究结果共纳入 330 838 名住院患者和 437 063 名门诊患者。13 020 名住院患者和 2 756 名门诊患者发生了 POUR。未经调整的结果显示，POUR 与住院病人更高的费用有关（有 P O U R 的 92 529 例与无 POUR 的 78 556 例相比，P 48 996 与无 POUR 的 35 433 例相比，P 10 668 ( 95 95 760- 11 760 , P .001）和 13 160（95% CI 11 750 - 14 571，p 9418）个门诊费用。结论与未发生 POUR 的患者相比，接受 NMB 药物逆转治疗并发生 POUR 事件的手术患者产生的费用更高。这些研究结果支持使用 NMB 逆转剂来降低 POUR 的发生率。

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Economic Impact of Postoperative Urinary Retention in the US Hospital Setting.

Background: Postoperative urinary retention (POUR) is a common and distressing surgical complication that may be associated with the pharmacological reversal technique of neuromuscular blockade (NMB). Objective: This study aimed to investigate the impact that POUR has on medical charges. Methods: This was a retrospective observational study of adult patients undergoing select surgeries who were administered neuromuscular blockade agent (NMBA), which was pharmacologically reversed between February 2017 and November 2021 using data from the PINC-AI™ Healthcare Database. Patients were divided into 2 groups: those experiencing POUR (composite of retention of urine, insertion of temporary indwelling bladder catheter, insertion of non-indwelling bladder catheter) during index hospitalization following surgery and those without POUR. Surgeries in inpatient and outpatient settings were analyzed separately. A cross-sectional comparison was performed to report total hospital charges for the 2 groups. Furthermore, patients experiencing subsequent POUR events within three days after discharge from index hospitalization were studied. Results: A total of 330 838 inpatients and 437 063 outpatients were included. POUR developed in 13 020 inpatients and 2756 outpatients. Unadjusted results showed that POUR was associated with greater charges in both inpatient ( $92 529 w i t h P O U R v s$ 78 556 without POUR, p < .001) and outpatient ( $48 996 w i t h P O U R v s$ 35 433 without POUR, p < .001) settings. After adjusting for confounders, POUR was found to be associated with greater charges with an overall mean adjusted difference of $10 668 (95$ 95 760- $11 760, p < .001) i n i n p a t i e n t a n d$ 13 160 (95% CI $11 750 -$ 14  571, p < .001) in outpatient settings. Charges associated with subsequent POUR events following discharge ranged from $9418 i n p a t i e n t c h a r g e s t o$ 1694 outpatient charges. Conclusions: Surgical patients who were pharmacologically reversed for NMB and developed a POUR event incurred greater charges than patients without POUR. These findings support the use of NMB reversal agents associated with a lower incidence of POUR.

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来源期刊

Journal of Health Economics and Outcomes Research Medicine-Health Policy

CiteScore

3.00

自引率

0.00%

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审稿时长

10 weeks