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Original article
DOI: 10.1016/j.cireng.2019.05.004
Analysis of Frequency, Type of Complications and Economic Costs of Outlying Patients in General and Digestive Surgery
Análisis de la frecuencia, tipos de complicación y costes económicos en los pacientes ectópicos de cirugía general y digestiva
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Juan-Carlos Gomez-Rosadoa,b,
Corresponding author
dr.gomez.rosado@gmail.com

Corresponding author.
, Yun-Hao Lib, Javier Valdés-Hernándeza, Fernando Oliva-Mompeána, Luis-Cristobal Capitán-Moralesa,b
a Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Departamento de Cirugía, Universidad de Sevilla, Sevilla, Spain
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Tables (4)
Table 1. Basic Characteristics of All Patients.
Table 2. Correlation and Frequency of the 15 Most Frequent DRG Included in Each Cohort.
Table 3. Distribution of Types and Consequences of Complications According to the Outlying/Non-outlying Location.
Table 4. Complications According to Gender; Evaluation of Risks.
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Abstract
Introduction

The shortage of available beds and the increase in Emergency Department pressure can cause some patients to be admitted in wards with available beds assigned to other services (outlying patients). The aim of this study is to assess the frequency, types of complications and costs of outlying patients.

Methods

Using a retrospective cohort model, we analyzed the 2015 general and digestive surgery records (source: Minimum Basic Data Set and economic database). After selecting all outlying patients, we compared the complications, length of stay, costs and consequences of complications against a randomized sample of non-outlying patients with the same DRG and date of episode for every outlying patient, obtaining one non-outlying patient for each selected outlying patient. Thirteen outlying patients with no non-outlying patient pair were excluded from the study.

Results

From a total of 2915 patients, 363 (12.45%) were outlying patients. A total of 350 outlying patients were analyzed versus 350 non-outlying patients. There were no significant differences in complications (9.4% vs 8.3%), length of stay (4.33 vs 4.65 days) or costs (€3034.12 vs €3223.27). Outlying patients men presented a significantly higher risk of complications compared to women (RR=2.10). Outlying patients presented complications after 2.5 or more days.

Conclusions

When outlying admissions become necessary, the selection of patients with less complex pathologies does not increase complications or their consequences (ICU admissions, readmissions, reoperations or mortality), hospital stays or costs. Only in cases of prolonged outlying stays of more than 2.5 days, or in males, may more complications appear. Therefore, male outliers should be avoided in general, and patients should be transferred to the proper ward if a length of stay beyond 2.5 days is foreseen.

Keywords:
Bed occupancy
Hospital length of stay
Post-operative complications
Costs and cost-analysis
General surgery
Public hospitals
Resumen
Introducción

El descenso de camas disponibles y el aumento de la presión de Urgencias provocan que algunos pacientes sean ingresados en salas con camas libres pertenecientes a otros servicios (llamados pacientes ectópicos). El objetivo de este artículo es analizar la frecuencia, los tipos de complicación y los costes en los pacientes ectópicos.

Métodos

Estudio retrospectivo de cohortes de pacientes ingresados a cargo de cirugía general y digestiva durante 2015 (fuente: Conjunto Mínimo Básico de Datos y contabilidad analítica). Comparamos las complicaciones, las estancias, los costes y las consecuencias de las complicaciones en todos los ectópicos, frente a un muestreo aleatorio de tantos pacientes no ectópicos como ectópicos ingresados en la misma fecha y con igual GRD. Se excluyen los 13 ectópicos sin par en los no ectópicos.

Resultados

De un total de 2.915 pacientes, 363 (12,45%) fueron ectópicos. Se analizan un total de 350 ectópicos frente a 350 no ectópicos. No hubo diferencias significativas en las complicaciones (9,4 vs 8,3%), las estancias (4,33 vs 4,65 días) ni el coste (3.034,12 vs 3.223,27€). Los hombres ectópicos presentan un riesgo significativamente mayor de complicaciones respecto a las mujeres (RR=2,10). Los ectópicos presentaron complicaciones a partir de 2,5 o más días como ectópicos.

Conclusiones

Al necesitar ingresos ectópicos, seleccionando pacientes de baja complejidad, no aumentamos las complicaciones ni sus consecuencias (ingresos en la UCI, reingresos, reintervenciones o mortalidad), estancias o costes. Solo en caso de prolongar la estancia ectópica más de 2,5 días, o en varones, pueden aparecer más complicaciones, por lo que deberían evitarse ectópicos varones, en general, y plantearse su traslado si se prevé una estancia más allá de 2,5 días.

Palabras clave:
Ocupación de camas
Estancias hospitalarias
Complicaciones postoperatorias
Costos y análisis de costo
Cirugía general
Hospitales públicos

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