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Diyabetik Ayak Hastalığında Ampütasyon Seviyesinin Hastane Maliyetleri ve Hastanede Kalış Süresi Üzerindeki Etkileri

Yıl 2020, Cilt: 25 Sayı: 3, 243 - 247, 29.10.2020
https://doi.org/10.21673/anadoluklin.774704

Öz

Amaç: Diyabetik ayak hastalığı (DAH), ciddi diyabet (mellitus) komplikasyonlarından biridir ve toplum için önemli bir finansal yük teşkil etmektedir. Bu çalışmada tedavisinde majör ampütasyon uygulanan DAH hastalarında ampütasyon seviyesinin hastane maliyetleri ve hastanede kalış süresi üzerindeki etkilerini değerlendirmek amaçlamıştır.


Gereç ve Yöntemler
: 2010—2017 yıllarında DAH tanısıyla hastanemize yatırılan ve majör ampütasyon uygulanan 72 hastaya dair veriler retrospektif olarak incelendi. Ampütasyonun uygulandığı seviyeye göre üç grup hasta tanımlandı: diz-altı ampütasyon (DAA) grubu, diz-üstü ampütasyon (DÜA) grubu, ve iki aşamalı (önce DAA sonra DÜA) ampütasyon (İAA) grubu. Hastane maliyetlerine ve hastanede kalış süresine dair veriler incelendi. Hastane maliyetleri dört kategoride değerlendirildi: ilaç maliyetleri, kaynak/malzeme maliyetleri, tetkik/tedavi maliyetleri, toplam maliyet. Sonuçlar Kruskal–Wallis tek yönlü varyans analiziyle karşılaştırıldı.


Bulgular
: Sırasıyla, DAA, DÜA ve İAA grupları 50 (25 erkek, 25 kadın), 11 (10, 1) ve 11 (9, 2) hastadan oluşmakta olup ortanca hasta yaşı 66, 64 ve 66 yıl idi. Sırasıyla, DAA, DÜA ve İAA grupları için ortanca ilaç maliyeti 1.058$, 1.072$, 2.240$, ortanca kaynak/malzeme maliyeti 223$, 405$, 1.349$, ortanca tetkik/tedavi maliyeti 2.628$, 2.405$, 3.587$, ortanca toplam maliyet 4.612$, 5.832$, 6.848$ olup ortanca yatış süresi ise 35 gün, 33 gün, 63 gün idi. Tüm maliyet kategorileri ve hastanede kalış süresi bakımından üç grup arasında istatistiksel olarak anlamlı fark tespit edilmedi (p>0,05).


Tartışma ve Sonuç:
DAH tedavisinde majör ampütasyon uygulanan hastalarda ampütasyon seviyesi hastanede kalış süreleri ve hastane maliyetleri açısından anlamlı bir fark oluşturur görünmemektedir.

Kaynakça

  • 1. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.
  • 2. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes. Epidemiology and prevention. Diabetes Care. 1989;12(1):24–31.
  • 3. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–28.
  • 4. Hobizal KB, Wukich DK. Diabetic foot infections: current concept review. Diabet Foot Ankle. 2012;3:10.3402/dfa.v3i0.18409.
  • 5. Jaacks LM, Siegel KR, Gujral UP, Narayan KM. Type 2 diabetes: a 21st century epidemic. Best Pract Res Clin Endocrinol Metab. 2016;30(3):331–43.
  • 6. Driver VR, Fabbi M, Lavery LA, Gibbons G. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg. 2010;52(Suppl. 3):17S–22S. [with correction in J Vasc Surg. 2010;52(6):1751].
  • 7. Hicks CW, Selvarajah S, Mathioudakis N, Sherman RL, Hines KF, Black JH, et al. Burden of infected diabetic foot ulcers on hospital admissions and costs. Ann Vasc Surg. 2016;33:149–58.
  • 8. Petrakis I, Kyriopoulos IJ, Ginis A, Athanasakis K. Losing a foot versus losing a dollar; a systematic review of cost studies in diabetic foot complications. Expert Rev Pharmacoecon Outcomes Res. 2017;17(2):165–80.
  • 9. Guest JF, Fuller GW, Vowden P. Diabetic foot ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018;15(1):43–52.
  • 10. Hopkins RB, Burke N, Harlock J, Jegathisawaran J, Goeree R. Economic burden of illness associated with diabetic foot ulcers in Canada. BMC Health Serv Res. 2015;15:13.
  • 11. Prompers L, Huijberts M, Schaper N, Apelqvist J, Bakker K, Edmonds M, et al. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia. 2008;51(10):1826–34.
  • 12. Oksuz E, Malhan S, Sonmez B, Numanoglu Tekin R. Cost of illness among patients with diabetic foot ulcer in Turkey. World J Diabetes. 2016;7(18):462–9.
  • 13. Shobhana R, Rao PR, Lavanya A, Vijay V, Ramachandran A. Foot care economics--cost burden to diabetic patients with foot complications: a study from southern India. J Assoc Physicians India. 2001;49:530–3.
  • 14. Driver VR, Goodman RA, Fabbi M, French MA, Andersen CA. The impact of a podiatric lead limb preservation team on disease outcomes and risk prediction in the diabetic lower extremity: a retrospective cohort study. J Am Podiatr Med Assoc. 2010;100(4):235–41.
  • 15. Driver VR, Madsen J, Goodman RA. Reducing amputation rates in patients with diabetes at a military medical center: the limb preservation service model. Diabetes Care. 2005;28(2):248–53.
  • 16. Zayed H, Halawa M, Maillardet L, Sidhu PS, Edmonds M, Rashid H. Improving limb salvage rate in diabetic patients with critical leg ischaemia using a multidisciplinary approach. Int J Clin Pract. 2009;63(6):855–8.
  • 17. Hartemann-Heurtier A, Ha Van G, Danan JP, Koskas F, Jacqueminet S, Golmard JL, et al. Outcome of severe diabetic foot ulcers after standardised management in a specialised unit. Diabetes Metab. 2002;28(6 Pt 1):477–84.

Effects of Amputation Level on Hospital Costs and Length of Hospital Stay in Diabetic Foot Disease

Yıl 2020, Cilt: 25 Sayı: 3, 243 - 247, 29.10.2020
https://doi.org/10.21673/anadoluklin.774704

Öz

Aim: Diabetic foot disease (DFD) is a serious complication of diabetes mellitus and also represents a considerable financial burden to society. In this study, we aimed to evaluate the effects of amputation level on hospital costs and length of hospital stay in patients with DFD who were treated with major amputations.


Materials and Methods:
Data of 72 patients who were hospitalized and underwent major amputations after a DFD diagnosis at our hospital between 2010 and 2017 were reviewed retrospectively. According to the level of amputation performed, three patient groups were identified: below-knee amputation (BKA) group, above-knee amputation (AKA) group, and two-stage (first BKA and then AKA) amputation (TSA) group. Data on hospital costs and length of hospital stay were reviewed. Hospital costs were evaluated under four categories: drug costs, resource/material costs, examination/treatment costs, and total costs.

Results were compared with Kruskal–Wallis one-way analysis of variance.

Results: The BKA, AKA, and TSA groups consisted of 50 (25 males, 25 females), 11 (10, 1), and 11 (9, 2) patients, with a median patient age of 66, 64, and 66 years, respectively. For the BKA, AKA, and TSA groups, the median drug cost was $1,058, $1,072, and $2,240, the median resource/material cost was $223, $405, and $1,349, the median examination/treatment cost was $2,628, $2,405, and $3,587, the median total cost was $4,612, $5,832, and $6,848, and the median length of hospital stay was 35 days, 33 days, and 63 days, respectively. In terms of all cost categories and length of hospital stay, no statistically significant difference was found between the three groups (p>0.05).


Discussion and Conclusion
: In DFD patients treated with major amputations, amputation level does not appear to make a significant difference in the amount of hospital costs and length of hospital stay.

Kaynakça

  • 1. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.
  • 2. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes. Epidemiology and prevention. Diabetes Care. 1989;12(1):24–31.
  • 3. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–28.
  • 4. Hobizal KB, Wukich DK. Diabetic foot infections: current concept review. Diabet Foot Ankle. 2012;3:10.3402/dfa.v3i0.18409.
  • 5. Jaacks LM, Siegel KR, Gujral UP, Narayan KM. Type 2 diabetes: a 21st century epidemic. Best Pract Res Clin Endocrinol Metab. 2016;30(3):331–43.
  • 6. Driver VR, Fabbi M, Lavery LA, Gibbons G. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg. 2010;52(Suppl. 3):17S–22S. [with correction in J Vasc Surg. 2010;52(6):1751].
  • 7. Hicks CW, Selvarajah S, Mathioudakis N, Sherman RL, Hines KF, Black JH, et al. Burden of infected diabetic foot ulcers on hospital admissions and costs. Ann Vasc Surg. 2016;33:149–58.
  • 8. Petrakis I, Kyriopoulos IJ, Ginis A, Athanasakis K. Losing a foot versus losing a dollar; a systematic review of cost studies in diabetic foot complications. Expert Rev Pharmacoecon Outcomes Res. 2017;17(2):165–80.
  • 9. Guest JF, Fuller GW, Vowden P. Diabetic foot ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018;15(1):43–52.
  • 10. Hopkins RB, Burke N, Harlock J, Jegathisawaran J, Goeree R. Economic burden of illness associated with diabetic foot ulcers in Canada. BMC Health Serv Res. 2015;15:13.
  • 11. Prompers L, Huijberts M, Schaper N, Apelqvist J, Bakker K, Edmonds M, et al. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia. 2008;51(10):1826–34.
  • 12. Oksuz E, Malhan S, Sonmez B, Numanoglu Tekin R. Cost of illness among patients with diabetic foot ulcer in Turkey. World J Diabetes. 2016;7(18):462–9.
  • 13. Shobhana R, Rao PR, Lavanya A, Vijay V, Ramachandran A. Foot care economics--cost burden to diabetic patients with foot complications: a study from southern India. J Assoc Physicians India. 2001;49:530–3.
  • 14. Driver VR, Goodman RA, Fabbi M, French MA, Andersen CA. The impact of a podiatric lead limb preservation team on disease outcomes and risk prediction in the diabetic lower extremity: a retrospective cohort study. J Am Podiatr Med Assoc. 2010;100(4):235–41.
  • 15. Driver VR, Madsen J, Goodman RA. Reducing amputation rates in patients with diabetes at a military medical center: the limb preservation service model. Diabetes Care. 2005;28(2):248–53.
  • 16. Zayed H, Halawa M, Maillardet L, Sidhu PS, Edmonds M, Rashid H. Improving limb salvage rate in diabetic patients with critical leg ischaemia using a multidisciplinary approach. Int J Clin Pract. 2009;63(6):855–8.
  • 17. Hartemann-Heurtier A, Ha Van G, Danan JP, Koskas F, Jacqueminet S, Golmard JL, et al. Outcome of severe diabetic foot ulcers after standardised management in a specialised unit. Diabetes Metab. 2002;28(6 Pt 1):477–84.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORJİNAL MAKALE
Yazarlar

Ömer Ergin Bu kişi benim 0000-0001-6848-6930

Koray Şahin 0000-0002-4759-4729

Emre Kocazeybek 0000-0001-5861-8653

Ahmet Yıldırım Bu kişi benim 0000-0003-4460-815X

İrfan Öztürk 0000-0001-7845-6794

Yayımlanma Tarihi 29 Ekim 2020
Kabul Tarihi 5 Ağustos 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 25 Sayı: 3

Kaynak Göster

Vancouver Ergin Ö, Şahin K, Kocazeybek E, Yıldırım A, Öztürk İ. Effects of Amputation Level on Hospital Costs and Length of Hospital Stay in Diabetic Foot Disease. Anadolu Klin. 2020;25(3):243-7.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.