Diyabetik Ayak Enfeksiyonlu Hastalarda Tedavi Maliyet Analizi: Retrospektif Bir Çalışma

Öz

Giriş: Diyabetik ayak enfeksiyonu (DAE) ve diyabetik ayak ülserleri (DAÜ) diyabetin yaygın komplikasyonlarındandır. Önemli bir halk sağlığı sorunu olan DAÜ yönetimi ve tedavisi sağlık sistemlerinde önemli boyutlarda ekonomik yük oluşturmaktadır. Bu nedenle DAE tanısıyla kliniğimizde yatırılarak tedavi ve bakımı yapılan hastalardaki genel maliyet boyutunu ortaya koymayı amaçladık. Materyal ve method: Retrospektif olarak gerçekleştirilen bu çalışmada kliniğimizde 1 Ocak 2018 ile 1 Ağustos 2020 tarihleri arasında DAE tanısıyla takip edilen 179 hasta dahil edildi. Hastanede yattıkları süre içerisindeki radyolojik görüntüleme, laboratuvar tetkikleri, muayene ve konsültasyon, yatak masrafı, medikal ve cerrahi tedavi (ampütasyon, debridman), pansuman maliyetleri dahil olmak üzere genel maliyet toplamları hesaplandı. Bulgular: Çalışmaya dahil edilen 179 DAE’lu hastanın yaş ortalaması 61.5±10.9 yıl ve 122’si (%68.2) erkekti. Hastaların ortalama diyabet süresi 13.7±6.5 yıldı. DAÜ’li hastaların IDSA sınıflamasına göre %55.9’u orta derece olup, %41.3’ünde osteomiyelit bulunuyor ve %15.6’sı hiperbarik oksijen tedavisi alıyordu. Çalışmada genel amputasyon sıklığı %26.8 olup, %22.9’unu minör amputasyonlar oluşturuyordu. Amputasyonlu vakaların %7.3’ü (n=13) ise birden fazla amputasyon geçirmişti. Hastaların %54.7’sinin çalışma süresi kapsamında tekrarlayan hastane yatışları söz konusuydu. Vakalarda genel mortalite sıklığı ise %2.8 idi. DAÜ’li hastaların ortalama kişi başı tedavi maliyeti 9181.9±5155.3 TL idi. Kişi başı maliyet ile tekrarlayan hospitalizasyonu olan hastalar (p<0.001) hariç, incelenen değişkenlerin hiçbiri anlamlı ilişki göstermedi (tümü için p>0.05) Sonuç: Hastaneye tekrarlayan yatışı olan hastalarla maliyet arasında anlamlı bir korelasyon vardır. DAÜ oluşumuna neden olan risk faktörleri ve ayak bakımını içeren farkındalık eğitim programları DM’lu hastalarda DAÜ oluşumunu ve buna bağlı gelişen ampütasyon gibi komplikasyon oranlarının azalmasına katkı sağlayacaktır.

Anahtar Kelimeler

• Diyabetik ayak enfeksiyonu
• diyabetik ayak ülser
• maliyet

Treatment Cost Analysis in Patients with Diabetic Foot Infection: A Retrospective Study

Abstract

Introduction: Diabetic foot infection (DFI) and diabetic foot ulcer (DFU) are widespread complications of diabetes. The management and treatment of DFU, an important public health problem, can result in a significant economic burden on health systems. The purpose of this study was to reveal the general cost dimension in patients hospitalized in our clinic for treatment and care with diagnoses of DFI. Materials and methods: One hundred seventy-nine patients followed-up with diagnoses of DFI in our clinic between 1 January, 2018, and 1 August, 2020, were included in this retrospective study. General cost totals including radiological imaging, laboratory tests, examination and consultation, bed costs, medical and surgical treatment (amputation, debridement), and dressing costs during patients’ hospital stays were calculated. Results: The mean age of the 179 patients with DFI in this study was 61.5±10.9 years, and 122 (68.2%) were men. Mean duration of diabetes was 13.7±6.5 years. Based on the Infectious Disease Society of America classification, 55.9% of the cases with DFU were moderate, osteomyelitis was present in 41.3%, and 15.6% were receiving hyperbaric therapy. The general prevalence of amputation was 26.8%, with minor amputations representing 22.9%. Thirteen (7.3%) of the amputation cases had undergone more than one amputation. Repeat hospitalizations were observed in 54.7% of the patients during the study period. The general mortality rate was 2.8%. The mean treatment cost per capita among the patients with DFU was 9181.9±5155.3 Turkish lira. With the exception of the repeat hospitalization cases (p<0.001), no significant association was determined between per capita cost and any of the demographic and clinical variables investigated(p>0.05 for all). Conclusion: There is a significant correlation between patients with repeated hospitalizations and cost. Awareness training programs including risk factors and foot care will contribute to a decrease in DFU development and related complications such as amputation in patients with diabetes mellitus.

Keywords

• Diabetic foot infection
• diabetic foot ulcer
• cost

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