Perioperative inhaled corticosteroids treatment is associated with decreased length-of-stay and direct medical costs in high-respiratory-risk surgeries

Abstract

Aims: To examine the impact of perioperative inhaled corticosteroids (ICS) on length-of-stay (LOS) and costs among patients receiving high-respiratory-risk surgeries.

Methods: Adult patients who underwent high-respiratory-risk surgeries in 2015 were identified in the Tianjin Urban Employee Basic Medical Insurance database. Patients were grouped into ICS or non-ICS cohorts according to whether they received ICS during the perioperative period of the index hospitalization. Propensity Score Matching was performed to create matched pairs between two cohorts. The impact of perioperative ICS on LOS and direct medical costs was estimated by negative binomial model and generalized liner model.

Results: Eight hundred and twenty-one hospital stays with high-respiratory-risk were selected in the ICS cohort and another 821 stays in the non-ICS cohort were matched. The mean LOS was 13.0 (±0.3) days in the ICS cohort, which was significantly lower than the matched non-ICS cohort. Patients with thorax and ear-nose-throat surgeries had a significant decrease in LOS in the ICS cohort compared to the non-ICS cohort, with a mean decrease of 5.5 and 1.1?days, respectively. In adjusted analyses, perioperative ICS treatment was associated with shorter LOS, lower total, and respiratory-related costs (reductions of 10.1%, 7%, and 5.3%, respectively) after controlling for demographic, clinical, and hospital characteristics.

Limitations: Some respiratory risk factors such as living behavior and environment were unable to be captured and respiratory-related costs might be underestimated, limited by claim data. Lastly, caution should be taken when generalizing the results to other populations, as only patients with moderate-to-severe surgeries on the thorax and above were selected in this study.

Conclusions: Perioperative ICS treatment was associated with decreased LOS and lower costs for patients undergoing high-respiratory-risk surgeries in China.     

短肽型肠内营养剂对结直肠癌围手术期患者的影响

目的探讨短肽型肠内营养剂对结直肠癌围手术期患者的影响。方法选取2017年6月至2019年8月滨州医学院附属医院收治的结直肠癌手术患者104例作为研究对象,随机分为试验组和对照组,各52例。试验组采用短肽型肠内营养剂进行营养支持,对照组患者采用传统清洁灌肠,比较患者手术前1 d及术后1 d、3 d、7 d IgC、IgA、IgM、CD3^+、CD4^+、CD8^+水平和术中肠道清洁情况。结果术后7 d,CD3^+、CD4^+逐渐升高,试验组的升高情况明显优于对照组,差异有统计学意义(P<0.05)。试验组患者术中肠道清洁情况与对照组比较,差异无统计学意义(P>0.05)。结论对结直肠癌患者围手术期采用短肽型肠内营养剂进行治疗,有利于患者术后免疫功能恢复。     

结核性脓胸围术期护理研究

目的：探讨结核性脓胸围术期护理效果。方法选取我院收治的结核性脓胸患者211例,将其按照随机数字法分为观察组和对照组,对照组患者给予常规护理,观察组患者给予围术期护理,比较两组患者的护理效果。结果观察组患者并发症发生率低,患者满意程度高,明显优于对照组（P＜0.05）。结论对结核性脓胸患者实施围术期护理,可有效减少并发症的发生率,提高患者及家属对护理服务的满意度。     

胃癌根治切除术治疗老年胃癌患者的疗效分析

目的探讨胃癌根治切除术治疗老年胃癌患者的疗效。方法对157例老年胃癌患者采用胃癌根治切除术治疗和围术期处理措施的效果进行回顾分析。结果 157例患者术后发生并发症39例,1年内病死56例。结论手术技术的进步和有力的围术期支持治疗,可以保证老年患者胃癌根治切除术患者取得较好疗效。     

急性脑梗死介入治疗围术期的护理效果

目的探讨急性脑梗死介入治疗围术期的护理效果。方法对49例急性脑梗死介入治疗患者的围术期护理进行分析。结果 49例患者术后影像学检查显示血管再通44例,血管未通5例,有效率达89.8%,均未出现脑出血、脑水肿等不良后遗症。患者3~4周出院,出院时可独立行走。结论加强急性脑梗死患者的围术期护理,严密观察病情及预防并发症的发生,对手术的成功起着至关重要的作用。     

普外科围术期预防应用抗菌药物的临床效果

目的探讨本院普外科围术期预防应用抗菌药物的临床效果,提升本院普外科围手术期预防应用抗菌药物的质量。方法本院于2012年1月起采取措施干预普外科围术期预防应用抗菌药物,随机抽取2010年(对照组)和2013年(观察组)普外科围术期预防应用抗菌药物患者各100例,回顾性分析其围术期预防应用抗菌药物情况。结果观察组患者抗菌药物费用以及住院总费用明显低于对照组,差异有统计学意义(P<0.05);观察组患者住院时间略低于对照组,差异无统计学意义(P>0.05);观察组预防用药选择、预防用药时机及预防用药疗程合理性明显优于对照组,差异有统计学意义(P<0.05);观察组用法用量合理性与对照组差异无统计学意义(P>0.05);观察组无指征联合用药、无依据换药比例明显低于对照组,差异有统计学意义(P<0.05)。结论采取干预措施可以在降低抗菌药物费用而不影响患者预后的基础上,提升围术期预防应用抗菌药物的合理性,减少无指征联合用药、无依据换药事件发生率。