目的:本研究调查了大麻使用障碍(CUD)对住院患者发病率的影响,停留时间(LOS)以及接受泌尿外科肿瘤手术患者的住院费用(IC)。
方法:对2003年至2014年的全国住院患者样本(NIS)进行了前列腺切除术的分析,肾切除术,或膀胱切除术(n=1,612,743)。使用ICD-9代码鉴定CUD。使用复杂的调查程序来比较有和没有CUD的患者。住院患者主要并发症,高LOS(第四四分位数),和高IC(第四四分位数)作为终点。进行单变量和多变量分析(MVA)以比较组。
结果:CUD的发生率从2003年的每100,000例入院51例增加到2014年的每100,000例383例(p<0.001)。总的来说,3,503名招生有CUD。CUD患者更年轻(50vs.61),男性(86%vs.78.4%),黑色(21.7%与9.2%),并拥有第一四分位数的收入(36.1%与20.6%);所有p<0.001。CUD对任何并发症发生率均无影响(均P>0.05)。然而,CUD患者的LOS较高(3vs.2天;p<0.001)和IC($15,609vs.$12,415;p<0.001)。在MVA上,CUD不是主要并发症的独立预测因子(p=0.6)。相反,CUD与高LOS(比值比(OR)1.31;95%CI1.08-1.59)和高IC(OR1.33;95%CI1.12-1.59)相关,两者p<0.01。
结论:泌尿外科手术时CUD的发生率正在增加。未来的研究应该研究我们观察到的现象的原因以及如何降低CUD患者的LOS和IC。
OBJECTIVE: This study examined the impact of cannabis use disorder (CUD) on inpatient morbidity, length of stay (LOS), and inpatient cost (IC) of patients undergoing urologic oncologic surgery.
METHODS: The National Inpatient Sample (NIS) from 2003 to 2014 was analyzed for patients undergoing prostatectomy, nephrectomy, or cystectomy (n = 1,612,743). CUD was identified using ICD-9 codes. Complex-survey procedures were used to compare patients with and without CUD. Inpatient major complications, high LOS (4th quartile), and high IC (4th quartile) were examined as endpoints. Univariable and multivariable analysis (MVA) were performed to compare groups.
RESULTS: The incidence of CUD increased from 51 per 100,000 admissions in 2003 to 383 per 100,000 in 2014 (p < 0.001). Overall, 3,503 admissions had CUD. Patients with CUD were more frequently younger (50 vs. 61), male (86% vs. 78.4%), Black (21.7% vs. 9.2%), and had 1st quartile income (36.1% vs. 20.6%); all p < 0.001. CUD had no impact on any complication rates (all p > 0.05). However, CUD patients had higher LOS (3 vs. 2 days; p < 0.001) and IC ($15,609 vs. $12,415; p < 0.001). On MVA, CUD was not an independent predictor of major complications (p = 0.6). Conversely, CUD was associated with high LOS (odds ratio (OR) 1.31; 95% CI 1.08-1.59) and high IC (OR 1.33; 95% CI 1.12-1.59), both p < 0.01.
CONCLUSIONS: The incidence of CUD at the time of urologic oncologic surgery is increasing. Future research should look into the cause of our observed phenomena and how to decrease LOS and IC in CUD patients.