Clinical Effect Of Transcatheter Closure Of Ventricular Septal Defect And Multifactor Analysis Of Hospitalization Expenses

Objective :To explore the therapeutic effect of transthoracic minimally invasive closure of ventricular septal defect in preschool children and the main factors affecting hospitalization costs.Methods :A retrospective analysis of the clinical data of 259 preschool children who underwent transthoracic closure or surgery under cardiopulmonary bypass in our hospital from January 2015 to December 2019,the propensity score matching method was used to compare the treatment effect,blood transfusion rate,intensive care unit stay,postoperative hospital stay,total hospital stay,postoperative antibiotic use time,antibiotic use cost and total hospitalization cost between the two groups;Correlation analysis and multiple linear regression analysis were used to explore the factors affecting hospitalization expenses.Results :A total of 112 cases were included in the study after matching(56 cases in the occlusion group,56 cases in the other group).In the occlusion group,blood transfusion rate(23% vs 91%,P<0.001),mechanical ventilation time(3.00/3.88 h vs10.00/16.75 h,P < 0.001),duration of intensive care unit(1.00/1.00 day vs3.00/3.00 day,P=0.001),postoperative hospital stay(7.16±4.43 day vs 10.32±3.89 day,P<0.001),total hospital stay(14.07±6.68 day vs 18.77±6.25 day,P<0.001),postoperative antibiotic use time(3.00/0.75 day vs 3.00/3.75 day,P<0.001)and antibiotic cost(1037.92/1686.51 yuan vs 1345.13/2839.21 yuan,P=0.050)were lower than those in the surgery group,the difference was statistically significant;There was no statistically significant difference in total hospitalization expenditure between the two groups(53853.97 ± 22620.18 yuan vs 56615.47 ±16418.24 yuan,P=0.461);Correlation analysis showed that age,body weight,sex,pulmonary artery pressure,NYHA cardiac function grade,VSD size,cardiothoracic ratio,mode of operation,complicated with pneumonia,year of hospitalization were significantly correlated with hospitalization cost(P<0.05),while ejection fraction was not significantly correlated with hospitalization cost(P>0.05).According to multiple linear regression analysis,there were significant differences in year of visit,body weight,NYHA cardiac function classification,pulmonary artery pressure and cardiothoracic ratio by multiple linear regression analysis.Among them,pulmonary artery pressure,year of visit,NYHA cardiac function grade and cardiothoracic ratio were positively correlated with hospitalization cost,while body weight was negatively correlated with hospitalization cost.According to the stepwise regression analysis,there is a significant correlation between hospitalization cost and the year of visit,body weight,NYHA cardiac function classification,pulmonary artery pressure and hospitalization expenses.Pulmonary hypertension has the greatest impact on hospitalization expenses,followed by body weight and year of treatment,and NYHA cardiac function classification has the least impact on hospitalization expenses.Conclusion:Transthoracic minimally invasive closure of ventricular septal defect can effectively reduce the use of blood products and antibiotics,while reducing the time of mechanical ventilation,the duration of the intensive care unit,the postoperative hospital stay and the total hospital stay,and it is more conducive to the rapid recovery of children;Pulmonary hypertension,year of treatment,weight and New York Heart function classification were the main factors influencing hospitalization expenses.