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首页> 外文期刊>Neurosurgical focus >Regional trends and the impact of various patient and hospital factors on outcomes and costs of hospitalization between academic and nonacademic centers after deep brain stimulation surgery for parkinson's disease: A United States Nationwide Inpatient Sample analysis from 2006 to 2010
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Regional trends and the impact of various patient and hospital factors on outcomes and costs of hospitalization between academic and nonacademic centers after deep brain stimulation surgery for parkinson's disease: A United States Nationwide Inpatient Sample analysis from 2006 to 2010

机译：区域趋势和各种患者和医院因素对帕金森病的深脑刺激手术后学术和非遗传中心住院的结果和成本：2006年至2010年美国全国住院病毒样本分析

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Object. The aim of this study was to analyze the incidence of adverse outcomes, complications, inpatient mortal-ity, length of hospital stay, and the factors affecting them between academic and nonacademic centers after deep brain stimulation (DBS) surgery for Parkinson's disease (PD). The authors also analyzed the impact of various factors on the total hospitalization charges after this procedure. Methods. This is a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2006 to 2010. Various patient and hospital variables were analyzed from the database. The adverse discharge disposition and the higher cost of hospitalization were taken as the dependent variables. Results. A total of 2244 patients who underwent surgical treatment for PD were identified from the database. The mean age was 64.22 ± 9.8 years and 68.7% (n = 1523) of the patients were male. The majority of the patients wasdischarged to home or self-care (87.9%, n = 1972). The majority of the procedures was performed at high-volume centers (64.8%, n = 1453), at academic institutions (85.33%, n = 1915), in urban areas (n = 2158, 96.16%), and at hospitals with a large bedsize (8.6%, n = 1907) in the West or South. Adverse discharge disposition was more likely in elderly patients (OR > 1, p = 0.011) with high comorbidity index (OR 1.508 [95% CI 1.148-1.98], p = 0.004) and those with complications (OR 3.155 [95% CI 1.202-8.279], p = 0.033). A hospital with a larger annual caseload was an independent predictor of adverse discharge disposition (OR 3.543 [95% CI 1.781-7.048], p < 0.001), whereas patients treated by physicians with high case volumes had significantly better outcomes (p = 0.006). The median total cost of hospitalization had increased by 6% from 2006 through 2010. Hospitals with a smaller case volume (OR 0.093, p < 0.001), private hospitals (OR 11.027, p < 0.001), nonteaching hospitals (OR 3.139, p = 0.003), and hospitals in the West compared with hospitals in Northeast and the Midwest (OR 1.885 [p = 0.033] and OR 2.897 [p = 0.031], respectively) were independent predictors of higher hospital cost. The mean length of hospital stay decreased from 2.03 days in 2006 to 1.55 days in 2010. There was no difference in the discharge disposition among academic versus nonacademic centers and rural versus urban hospitals (p > 0.05).Conclusions. Elderly female patients with nonprivate insurance and high comorbidity index who underwent surgery at low-volume centers performed by a surgeon with a low annual case volume and the occurrence of post-operative complications were correlated with an adverse discharge disposition. High-volume, government-owned academic centers in the Northeast were associated with a lower cost incurred to the hospitals. It can be recommended that the widespread availability of this procedure across small, academic centers in rural areas may not only provide easier access to the patients but also reduces the total cost of hospitalization.(http://thejns.org/doi/abs/10.3171/2013.8.FOCUS13295).
机译：目的。本研究的目的是分析不良成果，并发症，住院病人的发病率，医院住宿的长度，以及在深脑刺激（DBS）疾病（PD）的深脑刺激（DBS）手术后影响学术和非遗传症之间的因素。作者还分析了各种因素对此程序后的总住院费用的影响。方法。这是使用2006年至2010年的全国性住院样品（NIS）的回顾性队列研究。从数据库中分析了各种患者和医院变量。作为从属变量，将不利排放处理和更高的住院成本作为依赖变量。结果。共有2244例接受PD手术治疗的2244名患者。平均年龄为64.22±9.8岁，患者的68.7％（n = 1523）是男性。大多数患者均被收集到家庭或自我护理（87.9％，N = 1972）。大多数程序在高批中心（64.8％，N = 1453），在学术机构（85.33％，N = 1915），在城市地区（n = 2158,96.16％），以及医院西部或南部大床罩（8.6％，N = 1907）。具有高合并症指数（或1.508 [95％CI 1.148-1.98]，P = 0.004）和并发症（或3.155 [95％CI 1.202）的老年患者（或> 1，P = 0.011）更有可能更容易发生（或> 1，p = 0.011）更容易发生（或> 1，p = 0.011）更容易出现-8.279]，p = 0.033）。具有较大年度案例的医院是不利排放处理的独立预测因子（或3.543 [95％CI 1.781-7.048]，P <0.001），而受到高病例量的医生治疗的患者具有明显更好的结果（P = 0.006） 。从2006年至2010年，中位数的住院费用的总成本增加了6％。具有较小案例量的医院（或0.093，P <0.001），私人医院（或11.027，P <0.001），非换医院（或3.139，P = 0.003）和西部的医院与东北部的医院和中西部（或1.885 [P = 0.033]和或2.897 [P = 0.031]）是高等医院成本的独立预测因子。每年2.03天的住院住院的平均长度从2006年的2.03天降至2010年1.55天。学术与幼虫中心和城市医院的学术与城市医院的卸货处置没有差异（P> 0.05）.Conclusions。老年女性患者非竞争保险和高合成指数，在每年案例体积和术后并发症发生后的外科医生的低批量中心接受手术的患者接受手术和术后并发症的发生。高批量，东北地区的政府所有的学术中心都与医院产生的较低费用有关。可能建议在农村地区的小型学术中心普遍提供此程序的广泛可用性可能不仅可以更容易地访问患者，而且还降低了住院的总成本。（http://thejns.org/doi/abs/ 10.3171 / 2013.8.focus13295）。

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