Omer Naci Ergin, Irfan Ozturk, Koray Sahin, Emre Kocazeybek, Ahmet Mucteba Yildirim

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

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. Anahtar Sözcükler: ampütasyon; diabetes mellitus; diyabetik ayak hastalığı; diyabetik ayak ülseri

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

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

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