Analysis of Factors Affecting Hospitalization Costs for Type A Aortic Dissection Surgery Based on DRGs Group Payment Model
Objective To analyze the factors influencing the actual total hospitalization cost of patients with Type A aortic dissection coded by Disease Diagnosis Related Groups(DRGs).Methods Retrospective analysis of the first page of medical records of patients with aortic dissection surgery in the Cardiovascular Surgery Department of Henan Chest Hospital from December 2020 to December 2022 before and after the implementation of the DRGs payment model,and statistical analysis of changes in hospitalization cost structure and influencing factors before and after the implementation of the DRGs payment model.Results After the implementation of DRGs,the total hospitalization cost,surgery-related drug cost,and high-value surgical consumables cost of patients with Type A aortic dissection surgery were significantly reduced compared with before the implementation of DRGs,and the difference was statistically significant(P＜0.05).The structure of medical expenditure is mainly composed of high-value consumables and postoperative costs(complication treatment costs,postoperative care costs),among which the proportion of high-value consumables expenditure is the highest.The costs of thoracic aortic surgery without extremely severe or severe complications and comorbidities(FS14B group),thoracic aortic surgery with extremely severe or severe complications and comorbidities(FS14A group),and thoracic aortic interventional surgery(FS13Z group)were(98 685.95±299 0.18)yuan,(93 427.57±461 5.32)yuan,and(85 230.41±448 3.12)yuan,accounting for 34.94%,33.73%,and 30.32%respectively.The results of binary Logistic risk factor analysis of high-rate hospitalization costs of patients with Type A aortic dissection surgery showed that hospital stay≥7 d,ICU intervention frequency≥1 time,initial Acute Physiology and Chronic Health Evaluation Ⅱ(APACE Ⅱ)(≥10 points),initial brain natriuretic peptide(BNP)(≥450 pg/mL),cardiac positron emission tomography-computed tomography(PET-CT)examination(yes),number of artificial blood vessels(≥2),use of vascular stents(≥1),use of endovascular repair devices,use of artificial heart valves(≥1),use of"Da Vinci"surgical robot,age(≥65 years old)are the main risk factors affecting the hospitalization cost of Type A aortic dissection surgery,the difference is statistically significant(P＜0.05).Conclusion After the implementation of the DRGs group payment model,the hospitalization cost of aortic dissection surgery significantly decreased,which can provide a basis for the fine management of medical insurance funds and reasonable cost control for patients with aortic dissection surgery.
disease diagnosis related groupstype A aortic dissectionhospitalization cost
万方数据
维普
