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目的测算某大型综合医院高龄患者医院感染额外费用、住院天数、死亡率,为提高高龄患者医院感染管理水平提供数据支持。方法回顾性分析某医院2012年1月1日~2015年1月1日期间≥80岁的高龄住院患者资料,并用SPSS软件的PSM(倾向指数匹配法)对感染组和非感染组进行1:1匹配,得到组间协变量均衡的样本,并用SPSS19.0软件对新样本组间的额外费用、住院天数、死亡率进行统计分析。结果两组共成功匹配836对,感染组平均住院日中位数为31.0d,非感染组中位数为15.0d,差值中位数为16.0d(Z=-20.92,P<0.01)。感染组住院总费用中位数为101 912.9元,非感染组中位数为43 110.2元,差值中位数为58 802.7元(Z=-17.59,P<0.01)。日均感染费用为3 675.2元。增加的费用前四位依次为西药费30 084.7元、治疗费10 391.6元、化验费7 347.3元、材料费6 477.8元,占总费用的92.3%。感染组的死亡率为21.5%,非感染组的死亡率为16.6%,差值为4.9%(P<0.001)。结论 PSM测算结果提示,高龄患者医院感染危害大,是医院感染的极高危人群,必须高度重视,需加强目标性监测,并采取有效措施努力降低医院感染发生率。
Objective To estimate the additional cost of nosocomial infection, hospitalization days and mortality in elderly patients in a large general hospital and provide data support for improving the management of nosocomial infections in elderly patients. Methods A retrospective analysis was conducted on the data of hospitalized patients aged 80 years or older from January 1, 2012 to January 1, 2015 in a hospital. PSM (propensity index matching method) of SPSS software was used to compare the data of 1: 1 to get the sample of covariate equilibrium between groups. SPSS19.0 software was used to analyze the additional cost, hospitalization days and mortality of new sample groups. Results A total of 836 pairs were matched successfully in the two groups. The median length of stay was 31.0 days in the infected group and 15.0 days in the non-infected group. The median difference was 16.0 days (Z = -20.92, P <0.01). The median hospitalization cost was 101 912.9 yuan in the infected group, 43 110.2 yuan in the non-infected group, and the median difference was 58 802.7 yuan (Z = -17.59, P <0.01). The average daily infection cost was 3 675.2 yuan. The top four in terms of costs were medical expenses of 30,084.7 yuan, medical treatment costs of 10,391.6 yuan, laboratory costs of 7,347.3 yuan and materials costs of 6,477.8 yuan, accounting for 92.3% of the total costs. Mortality was 21.5% in the infected group and 16.6% in the non-infected group, with a difference of 4.9% (P <0.001). Conclusions The results of PSM suggest that elderly patients with high nosocomial infections are very high risk groups of nosocomial infections. They must attach great importance to this problem. Target monitoring should be strengthened and effective measures should be taken to reduce the incidence of nosocomial infections.