Impact of cardiac surgery and neurosurgery patients on variation in severity-adjusted resource use in intensive care units.

Takala, Jukka; Moser, André; Reinikainen, Matti; Varpula, Tero; Raj, Rahul; Jakob, Stephan M (2022). Impact of cardiac surgery and neurosurgery patients on variation in severity-adjusted resource use in intensive care units. Journal of critical care, 71, p. 154110. Elsevier 10.1016/j.jcrc.2022.154110

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PURPOSE

The resource use of cardiac surgery and neurosurgery patients likely differ from other ICU patients. We evaluated the relevance of these patient groups on overall ICU resource use.

METHODS

Secondary analysis of 69,862 patients in 17 ICUs in Finland, Estonia, and Switzerland in 2015-2017. Direct costs of care were allocated to patients using daily Therapeutic Intervention Scoring System (TISS) scores and ICU length of stay (LOS). The ratios of observed to severity-adjusted expected resource use (standardized resource use ratios; SRURs), direct costs and outcomes were assessed before and after excluding cardiac surgery or cardiac and neurosurgery.

RESULTS

Cardiac surgery and neurosurgery, performed only in university hospitals, represented 22% of all ICU admissions and 15-19% of direct costs. Cardiac surgery and neurosurgery were excluded with no consistent effect on SRURs in the whole cohort, regardless of cost separation method. Excluding cardiac surgery or cardiac surgery plus neurosurgery had highly variable effects on SRURs of individual university ICUs, whereas the non-university ICU SRURs decreased.

CONCLUSIONS

Cardiac and neurosurgery have major effects on the cost structure of multidisciplinary ICUs. Extending SRUR analysis to patient subpopulations facilitates comparison of resource use between ICUs and may help to optimize resource allocation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Takala, Jukka, Moser, André, Jakob, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0883-9441

Publisher:

Elsevier

Funders:

[229] UNSPECIFIED

Language:

English

Submitter:

Pubmed Import

Date Deposited:

11 Jul 2022 14:33

Last Modified:

20 Feb 2024 14:16

Publisher DOI:

10.1016/j.jcrc.2022.154110

PubMed ID:

35803010

Uncontrolled Keywords:

Cardiac surgery Cost control Health care benchmarking Health resources Hospital mortality Intensive care unit Neurosurgery Resource allocation

BORIS DOI:

10.48350/171196

URI:

https://boris.unibe.ch/id/eprint/171196

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