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Abstract：
BACKGROUND: Many commercial and artisanal devices are utilized for temporary abdominal closure in patients being managed with an open abdomen for abdominal sepsis. The costs of materials required to treat patients with an open abdomen varies drastically. In Costa Rica, due to the lack of accurate information relating to the actual cost to manage a patient entails that the method with the least expensive materials is usually selected.
METHODS: A single-center retrospective review of 46 patients diagnosed with abdominal sepsis and successfully treated with an open abdomen and one of the three temporary abdominal closure methods during the year 2018 in a tertiary hospital was evaluated using a gross-cost pricing model developed by the authors. The three temporary abdominal closure methods were a locally manufactured Bogota Bag, and commercial abdominal negative pressure therapy dressing and negative pressure therapy with 0.9% saline solution instillation. The per-unit-costs were hospital day and intensive care day, number of surgical procedures per patient, cost negative pressure therapy kits.
RESULTS: Statistically significant cost reduction was observed in the cohort treated with negative pressure therapy with instillation as compared to the other temporary abdominal closure methods. The reduction of hospital length of stay, as well as fewer number of surgeries were the main contributing factors in diminishing costs. On average, the costs to treat a patient utilizing negative pressure therapy with instillation was nearly 50% lower than using the other two temporary abdominal closure methods.
CONCLUSIONS: The costs relating to managing abdominal sepsis in the septic open abdomen vary greatly according to the temporary abdominal closure utilized. If the hospital length of stay, intensive care unit length of stay and number of surgeries required are the main parameters used in determining costs, the use of negative pressure therapy with 0.9% saline solution instillation reduces costs by nearly 50% in comparison to conventional negative pressure wound therapy and Bogota Bag. In this instance, the more expensive method at first glance, obtained a considerable cost reduction when compared to therapies that utilize less expensive materials.
METHODS: A single-center retrospective review of 46 patients diagnosed with abdominal sepsis and successfully treated with an open abdomen and one of the three temporary abdominal closure methods during the year 2018 in a tertiary hospital was evaluated using a gross-cost pricing model developed by the authors. The three temporary abdominal closure methods were a locally manufactured Bogota Bag, and commercial abdominal negative pressure therapy dressing and negative pressure therapy with 0.9% saline solution instillation. The per-unit-costs were hospital day and intensive care day, number of surgical procedures per patient, cost negative pressure therapy kits.
RESULTS: Statistically significant cost reduction was observed in the cohort treated with negative pressure therapy with instillation as compared to the other temporary abdominal closure methods. The reduction of hospital length of stay, as well as fewer number of surgeries were the main contributing factors in diminishing costs. On average, the costs to treat a patient utilizing negative pressure therapy with instillation was nearly 50% lower than using the other two temporary abdominal closure methods.
CONCLUSIONS: The costs relating to managing abdominal sepsis in the septic open abdomen vary greatly according to the temporary abdominal closure utilized. If the hospital length of stay, intensive care unit length of stay and number of surgeries required are the main parameters used in determining costs, the use of negative pressure therapy with 0.9% saline solution instillation reduces costs by nearly 50% in comparison to conventional negative pressure wound therapy and Bogota Bag. In this instance, the more expensive method at first glance, obtained a considerable cost reduction when compared to therapies that utilize less expensive materials.
摘要：
背景:许多商业和手工装置被用于对腹部败血症用开放腹部进行管理的患者的临时腹部闭合。治疗腹部开放患者所需的材料成本差异很大。在哥斯达黎加,由于缺乏与管理患者的实际成本有关的准确信息，通常需要选择使用最便宜材料的方法。
方法：使用作者开发的总成本定价模型，评估了2018年在三级医院诊断为腹部脓毒症并成功采用开腹和三种临时腹部闭合方法之一治疗的46例患者。三种临时腹部闭合方法是当地制造的波哥大袋，和商业腹部负压治疗敷料和使用0.9％盐溶液滴注的负压治疗。单位成本是住院日和重症监护日，每位患者的外科手术次数，成本负压治疗试剂盒。
结果：与其他临时腹部闭合方法相比，在采用负压滴注治疗的队列中观察到统计学上显著的成本降低。减少住院时间，手术数量减少是成本下降的主要因素。平均而言,使用负压滴注治疗的患者的治疗费用比使用另外两种临时腹部闭合方法低了近50%.
结论：根据所使用的临时腹部闭合，与在败血症开放腹部中管理腹部败血症相关的成本差异很大。如果住院时间长短，重症监护病房的住院时间和所需的手术次数是确定成本的主要参数，与传统的负压伤口疗法和BogotaBag相比，使用0.9％盐溶液滴注的负压疗法可将成本降低近50％。在这种情况下，乍一看更昂贵的方法，与使用较便宜材料的疗法相比，获得了相当大的成本降低。
方法：使用作者开发的总成本定价模型，评估了2018年在三级医院诊断为腹部脓毒症并成功采用开腹和三种临时腹部闭合方法之一治疗的46例患者。三种临时腹部闭合方法是当地制造的波哥大袋，和商业腹部负压治疗敷料和使用0.9％盐溶液滴注的负压治疗。单位成本是住院日和重症监护日，每位患者的外科手术次数，成本负压治疗试剂盒。
结果：与其他临时腹部闭合方法相比，在采用负压滴注治疗的队列中观察到统计学上显著的成本降低。减少住院时间，手术数量减少是成本下降的主要因素。平均而言,使用负压滴注治疗的患者的治疗费用比使用另外两种临时腹部闭合方法低了近50%.
结论：根据所使用的临时腹部闭合，与在败血症开放腹部中管理腹部败血症相关的成本差异很大。如果住院时间长短，重症监护病房的住院时间和所需的手术次数是确定成本的主要参数，与传统的负压伤口疗法和BogotaBag相比，使用0.9％盐溶液滴注的负压疗法可将成本降低近50％。在这种情况下，乍一看更昂贵的方法，与使用较便宜材料的疗法相比，获得了相当大的成本降低。
