Mehmet YILDIRIM, Ahmet Deniz UÇAR, Erkan OYMACI

DOES DIRECT HEALTHCARE COSTS CONTINUE TO BE A PROBLEM IN THE BURN CENTER DUE TO MANY COMPONENTS?

Introduction: Although it is not possible to calculate the patient's harm to the work life and economy due to burns, knowing the direct health costs in the burns center is important in determining which patient groups are high-budgeted and preparing the budget for the next years. In this study, we aimed to evaluate the relationship between age, total burn surface area (TBSA) and length of hospital stay(LOS) with cost in 2018, the highest invoice cost in the last five years. Material and Method: A retrospective study was conducted from January 2018 to December 2018 that included 177 patients with a history of a burn injury. Results: There was a prdominance of males. Median age was 39,2 years old. The total median cost per person was 6.428 TL and the daily cost was 377 TL. There was no statistically significant relationship between between age and cost (p = 0.061). There was a statistically significant relationship between TBSA burns and cost (p = 0.000). The average LOS was 17 days. Burning percentage had a significant effect on LOS (p = 0.000). The amount of days spent in the hospital was found to be significantly associated with cost (p = 0.000). Conclusion: In our series, burn costs were found to be very low, and we think that the main factor in this result is the development of burn centers' specialized treatment algorithms.

ÇOKLU BİLEŞENİNDEN DOLAYI DİREKT SAĞLIK MALİYETLERİ YANIK MERKEZİNDE SORUN OLMAYA DEVAM EDİYOR MU?

Giriş: Yanığa bağlı olarak hastasının iş hayatı ve ekonomiye olan zararının hesap edilmesi tam olarak mümkün olmamakla birlikte, yanık merkezinde direkt sağlık masraflarının bilinmesi, hangi hasta gruplarının yüksek bütçeli olduğunun belirlenerek gelecek yılların bütçesinin hazırlanmasında önem taşımaktadır. Gereç ve Yöntem: Bizde bu çalışmada son 5 yıl içerisinde fatura maliyeti en yüksek olan 2018 yılında yaş, toplam vücut yanık alanı ve hastanede kalış süresinin maliyet ile ilişkisini değerlendirmeyi amaçladık. Bulgular: Bu çalışma 177 olguyu içermekte olup, kişi başı ortalama toplam maliyet 6.428 TL, günlük maliyet 377 TL'dir. Yaş ve maliyet arasında istatistiksel olarak anlamlı bir ilişki yoktu (p = 0.061). Toplam vücut alanı yanıkları ile maliyet arasında istatistiksel olarak anlamlı bir ilişki vardı (p = 0.000). Hastanede kalış ortalama 17 gündü. Toplam yanık alanı hastanede kalış üzerinde anlamlı bir etkiye sahipti (p = 0.000). Hastanede geçirilen gün sayısı maliyetle anlamlı düzeyde ilişkili olduğu bulundu (p = 0.000). Sonuç: Bizim serimizde yanık maliyetleri oldukça düşük bulunmuş olup, bu sonuçta başlıca etkenin özelleşmiş yanık merkezlerinin tedavi algoritmalarını geliştirmesi olduğunu düşünmekteyiz.

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1. Sanchez JLA, Bastida JL, Martı´nez MM, Moreno JMM, Chamorro JJ. Socio-economic cost and health-related quality of life of burn victims in Spain. Burns 2008; 34(7): 975 –81.

2. Hop MJ, Polinder S, van der Vlies CH, Middelkoop E, van Baar ME. Costs of burn care: a systematic review. Wound Repair Regen. 2014; 22(4): 436-50.

3. Nursal TZ, Yildirim S, Tarim, A, Caliskan K, Ezer A, Noyan T. Burns in southern Turkey: electrical burns remain a major problem. Journal of Burn Care & Rehabilitation 2003; 24(5): 309-14.

4. Van Lieshout EMM, Van Yperen DT, Van Baar ME, Polinder S, Boersma D,Cardon AYMVP et al. Epidemiology of injuries, treatment (costs) and outcome in burn patients admitted to a hospital with or without dedicated burn centre (Burn-Pro): protocol for a multicentre prospective observational study. BMJ Open 2018; 8(11): e023709.

5. Lofts JA. Cost analysis of a major burn. NZ Med J 1991; 104(924): 488-90.

6. Eldad A, Stern Z, Sover H, Neuman R, Ben Meir P, Wexler MR. The cost of an extensive burn survival. Burns 1993; 19(3): 235–8.

7. Anami EHT, Zampar EF, Tanita MT, Cardoso LTQ, Matsuo T, Grion CMC. Treatment costs of urn victims in a university hospital. Burns 2017; 43(2): 350-6.

8. Patil V, Dulhunty JM, Udy A, Thomas P, Kucharski G, Lipman J. Do burn patients cost more? The intensive care unit costs of burn patients compared with controls matched for length of stay and acuity. J Burn Care Res 2010; 31(4): 598-602.

9. Cruz BF, Cordovil PBL, Batista KNM. Perfil epidemiológico de pacientes que so-freram queimaduras no Brasil: revisão de literatura. Rev Bras Queimaduras 2012; 11(4): 246-50.

10. .Haikonen K, Lillsunde PM, Vuola J.Inpatient costs of fire-related injuries in Finland. Burns 2014;40(8):1754-60.

11. Endo A, Shiraishi A,Otomo Y,Fushimi K,Murata K.Volume-outcome relationship on survival and cost benefits in severe burn injury: a retrospective analysis of a Japanese nationwide administrative database. Journal of Intensive Care 2019 7:7

12. Ahn CS, Maitz PKM. The true cost of burn.Burns 2012; 38(7): 967-74.

13. Eser T, Kavalci C, Aydogan C , Kayipmaz AE. Epidemiological and cost analysis of burn injuries admitted to the emergency department of a tertiary burn center. Springerplus 2016; 5(1): 1411.

14. Rezaee R, Alimohamadzadeh K, Hosseini SM. Epiemiologic features and hospitalization cost of burn ınjuries in Iran Based on National Burn Registry; a Crosssectional study. Archives of Academic Emergency Medicine. 2019; 7 (1): e65.

15. Sahin I, Ozturk S, Alhan D, Açıkel C, Isik S. Cost analysis of acute burn patients treated in a burn centre: the Gulhane experience. Annals of Burns and Fire Disasters 2011; 24(1): 9-13.

16. Taheri PA,Butz DA,Greenfield LJ.Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg 2000; 191(2): 123-30.

17. Jansen LA, Hynes SL, Macadam SA, Papp A. Reduced length of stay in hospital for burn patients fllwing a change in practice guidelines:Financial implications. J Burn & Care Research 2012; 33(6): e275-279.

18. Maan ZN, Frew Q, Din AH, Unluer Z, Smailes S, Philp B et al. Burns ITU admission: length of stay in specific levels of care for adult and paediatric patients. Burns 2014;40(8):1458-62.

19. Pellatt RA, Williams A, Wright H, Young AE. The cost of a major paediatric burn. Burns 2010; 36(8): 1208–14.

20. Papp A, Rytkönen T, Koljonen V, Vuola J. Paediatric ICU burns in Finland 1994–2004. Burns 2008; 34(3): 339–44.

21. Taylor SL, Sen S, Greenhalgh DG, Lawless MB, Curri T, Palmieri TL. Real-time prediction for burn length of stay via median residual hospital length of stay methodology. J Burn & Care Research 2016; 37(5): e476-82.

22. Goswami P, Sahu S, Singodia P, Kumar M, Tudu T, Kumar A et al. Early excision and grafting in burns: an experience in a tertiary care industrial hospital of Eastern India. Indian J Plast Surg 2019; 52(3): 337–42.