目的:评估在美国接受胸外科手术的成年人中白蛋白的使用,比较基线特征,受者与非受者的临床和成本结果,并确定白蛋白对医院总费用的贡献。
方法:回顾性队列研究。
方法:美国医院的全国样本。
方法:2011年至2017年期间接受开放和微创胸外科手术的成年人。
方法:手术当天的白蛋白(使用逐项的医院账单记录确定)。
结果:美国342家医院中有170家使用了白蛋白,在14,672和22,532名患者的13%和7%中,分别,接受了开胸和微创手术(中位容量500mL)。基线合并症和器官支持治疗在接受者中更为普遍(尤其是血管加压药,机械通气,和红细胞输血)。在标准化死亡率倾向得分加权分析中,白蛋白使用与住院死亡率无关(调整后相对危险度1.17[0.72,1.92]和1.51[0.97,2.34],采用开放式和微创手术),但与发病率和更高的成本有关,微创手术比开放手术更重要。开放和微创手术的总费用分别增加了4,744美元(3,591美元,5,897美元)和5,088美元(4,075美元,6,100美元),分别。白蛋白占这种差异的2.6%(每位患者中位数$124[$83-$189])。
结论:白蛋白的使用在各个医院之间差异很大,9%的患者接受了它(中位数500mL)。使用与住院死亡率无关,并且与更多的发病率和成本相关。白蛋白的费用占医院费用的一小部分。临床试验必须检查白蛋白对胸部手术后并发症和费用的影响。
OBJECTIVE: To estimate the use of albumin among adults undergoing thoracic surgery in the United States, compare baseline characteristics, clinical and cost outcomes of recipients versus nonrecipients, and determine albumin\'s contribution to total hospital costs.
METHODS: Retrospective cohort study.
METHODS: Nationwide sample of US hospitals.
METHODS: Adults undergoing open and minimally invasive thoracic surgery between 2011 and 2017.
METHODS: Albumin on the day of surgery (identified using itemized hospital billing logs).
RESULTS: Albumin was used in 170 of 342 US hospitals, among 13% and 7% of 14,672 and 22,532 patients who, respectively, underwent open and minimally invasive thoracic surgery (median volume 500 mL). Baseline comorbidities and organ-supportive treatments were several-fold more prevalent among recipients (particularly vasopressors, mechanical ventilation, and red cell transfusions). In standardized mortality ratio propensity score weighted analysis, albumin use was not associated with in-hospital mortality (adjusted relative risk 1.17 [0.72, 1.92] and 1.51 [0.97, 2.34], with open and minimally invasive procedures), but was associated with morbidity and higher costs, more so with minimally invasive procedures than with open surgery. Total costs among recipients were higher by $4,744 ($3,591, $5,897) and $5,088 ($4,075, $6,100) for open and minimally invasive procedures, respectively. Albumin accounted for 2.6% of this difference (median $124 [$83-$189] per patient).
CONCLUSIONS: Albumin use varies widely across hospitals, and 9% of patients receive it (median 500 mL). Use was not associated with in-hospital mortality and was associated with more morbidity and cost. The cost of albumin accounted for a trivial portion of hospital costs. Clinical trials must examine the effects of albumin on complications and costs after thoracic surgery.