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| 老年患者术前主要心血管不良事件风险评估与医疗费用的相关性 |
| The correlation between preoperative risk assessment of major adverse cardiovascular events and costs in elderly patients |
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| DOI：10.12089/jca.2022.02.012 |
| 中文关键词: 老年 术前评估 医疗费用 主要心血管不良事件 |
| 英文关键词: Aged Preoperative assessment Medical expenses Major cardiovascular adverse events |
| 基金项目:国家重点研发计划项目资助（2018YFC2001800）；国家老年疾病临床医学研究中心项目资助（Z2018A02）；四川省科技厅重点研发项目（2019YFG0491） |
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| 中文摘要: |
目的 分析老年患者术前主要心血管不良事件（MACEs）风险评估与围术期麻醉费用及住院总费用的相关性，探讨优化医疗保险支付制度的新路径。
方法 前瞻性选择2020年1—12月本院行全身麻醉下手术的老年患者5 642例，男3 152例，女2 490例，年龄≥65岁，BMI 16~36 kg/m2，ASA Ⅰ—Ⅳ级。所有患者术前进行术后MACEs的标准化评估，根据术前评估结果将患者分为三组：低危组（n=4 520）、中危组（n=743）和高危组（n=379），比较不同危险层级患者术后MACEs的发生情况及医疗费用差异。
结果 本研究共纳入老年患者5 642例，术后30 d MACEs发生率为154例（2.73%），其中，低危组39例（0.86%），中危组55例（7.40%），高危组60例（15.83%）。与低危组比较，中危组和高危组麻醉费用、住院费用明显增加（P<0.001），住院时间明显延长（P<0.001）。与中危组比较，高危组麻醉费用、住院费用明显增加（P<0.001），住院时间明显延长（P<0.001）。骨科手术中，中危组和高危组麻醉费用明显高于低危组（P<0.05），住院时间明显长于低危组（P<0.05）。心脏手术中，高危组住院时间明显长于中危组（P<0.05）。
结论 术前评估可有效预测术后MACEs的发生风险和患者医疗费用支出，可为优化外科患者医保分组付费提供依据。 |
| 英文摘要: |
Objective To analyze the relationship between preoperative risk assessment of major cardiovascular adverse events (MACEs) and perioperative anesthesia costs and hospitalization costs in elderly patients, and to explore a new path to optimize the medical insurance payment system.
Methods A total of 5 642 elderly patients who underwent general anesthesia from January 2020 to December 2020 were prospectively enrolled for standardized preoperative evaluation of postoperative MACEs, 3 152 males and 2 490 females, aged ≥ 65 years, BMI 16-36 kg/m2, ASA physical status Ⅰ-Ⅳ, were divided into three groups: low-risk group (n = 4 520), medium-risk group (n = 743), and high-risk group (n = 379) according to preoperative evaluation rules. The incidence of postoperative MACEs and the differences in medical insurance costs among patients with different risk levels were compared.
Results A total of 5 642 elderly patients were included, and 154 patients (2.73%) developed MACEs after surgery, including 39 patients in the low-risk group (0.86%), 55 patients in the medium-risk group (7.40%), and 60 patients in the high-risk group (15.83%). Compared with low-risk group, the anesthesia cost and hospitalization cost were significantly higher in medium and high-risk group (P < 0.001), and the duration of hospitalization was markedly longer in medium and high-risk group (P < 0.001). Compared with the medium-risk group, the anesthesia cost and hospitalization cost were significantly higher (P < 0.001) in the high-risk group, and the duration of hospitalization was significantly longer (P < 0.001). Compared with low-risk group, the anesthesia cost of orthopedic surgery in medium-risk group and high-risk group were significantly higher (P < 0.05), and the duration of hospitalization of orthopedic surgery in medium-risk group and high-risk group were significantly longer (P < 0.05). Compared with medium-risk group, the duration of hospitalization of cardiac surgery in high-risk group was significantly longer (P < 0.05).
Conclusion Preoperative evaluation can effectively predict the risk of postoperative MACEs and the level of medical expenses of patients, which can provide a basis for optimizing medical insurance group payment for surgical patients． |
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