Analysis Of Risk Factors And Hospitalization Expenses Of Acute Pancreatitis In Qinghai From 2016-2018

Objective: Retrospective analysis of the medical records and hospitalization expenses of the inpatients with acute pancreatitis from January 2016 to December 2018 in Qinghai Provincial People's Hospital,to analyze the difference of clinical indexes between patients with non severe acute pancreatitis and severe acute pancreatitis,and to establish a new prediction model for severe acute pancreatitis,to explore the influencing factors of hospitalization expenses of patients with acute pancreatitis,and put forward reasonable suggestions for reducing hospitalization expenses of patients with acute pancreatitis.Method: The hospital management information system?HIS?of Qinghai Provincial People's hospital was used to collect the medical records and hospitalization expenses of patients with acute pancreatitis hospitalized from January 2016 to December 2018,Using Excel 2010 software to establish database and SPSS 19.0 software was used for statistical analysis,nonparametric test and chi square test were used for single factor analysis of clinical records and hospitalization expenses,binary logistic regression was used to establish a new prediction model for patients with acute pancreatitis,ROC curve was drawn to evaluate the prediction effect of the new prediction model with bisap score,Ranson score and CTSI score system,Spearman rank correlation analysis was used for hospitalization days,Binary logistic regression was used to analyze the influencing factors of hospitalization expenses.Result:1.Basic information From 2016 to 2018,819 patients with acute pancreatitis were admitted to the general surgery department of Qinghai Provincial People's hospital.According to the diagnosis standard of acute pancreatitis formulated at the Atlanta conference in 2012,771 patients with acute pancreatitis met the requirements of this study,including 701 patients with non severe acute pancreatitis and 70 patients with severe acute pancreatitis.The patients with non severe acute pancreatitis were mainly from Xining and Haidong,accounting for 32.67%?229/701?and 32.52%?228/701?,followed by Haibei,Hainan and Haixi,accounting for 9.7%?68/701?,8.27%?58/701?and 5.28%?37/701?respectively,and the patients aged 46-60 were mainly from 35.24%?247/701?,The youngest patients were 16 years old,the maximum age was 89 years old,the average age was 45.93±14.99.The Han nationality accounted for?47.08%?330/701??,followed by Hui nationality?21.26%?149/701??and the occupation distribution mainly consisted of farmers,accounting for 59.20%?415/701?.The incidence rate of male gender was higher than that of women,and male and female accounted for 65.71%?46/70?and 34.29%?24/70?respectively.Hospital days were mainly distributed in 11-20 days,accounting for 51.64%?362/701?;biliary pancreatitis was the main cause,accounting for 47.08%?482/701?,followed by alcoholic pancreatitis,accounting for 21.26%?98/701?;70 cases of severe acute pancreatitis were mainly in Haidong and Xining,accounting for 31.43%?22/70?and 24.29%?17/70?,followed by Haibei,Hainan and Haixi,respectively The patients aged 61-75 accounted for 34.29%?24/70?,The youngest was 26 years old,the maximum age was 86 years old,the average age was 56.20±15.81.The Han nationality was the main Han nationality?44.29%?31/70??,followed by Hui nationality(24.29%?17/70?,the main occupation was peasants?59.20%?415/701??,and the incidence rate of male gender was higher than that of female,and male and female accounted for 65.71%?46/70?and 34.29%?24/70?respectively.It was mainly distributed in 31-40 days,accounting for 42.86%?30/70?;the main inducement was biliary pancreatitis,accounting for 52.86%?37/70?.2.Univariate analysis of clinical data There were statistically significant differences in age?Z=-2.217,P < 0.05?,CTSI score?Z=-8.162,P < 0.05?,BISAP score?Z=-10.256,P < 0.05?,Ranson score?Z=-9.644,P < 0.05?,urea nitrogen?Z=-3.362,P < 0.05?,albumin?Z=-3.156,P < 0.05?,triglycerides?Z=-2.317,P < 0.05?between the two groups.3.A new model for predicting the severity of acute pancreatitis Age?X₁?,albumin?X₃?and triglyceride level?X₄?are the main factors affecting the severity of acute pancreatitis,the new prediction equation was: ln [P/?1-P?]=0.348X₁-0.251X₃+0.876X₄-1.407.The area under the ROC curve of the new prediction model was 0.952,the sensitivity was 0.930,the specificity was 0.918,the positive predictive value was 95.35%,and the negative predictive value was 82.02%.4.Univariate analysis of hospital expenses The hospitalization cost of acute pancreatitis patients in different age groups was significantly different??²=10.506,P < 0.05?.The hospitalization cost of acute pancreatitis patients with different hospitalization days was significantly different??²=335.171,P < 0.05?.The hospital expenses of patients with different types of acute pancreatitis were significantly different,and the difference was statistically significant?Z=-7.824,P < 0.05?.The hospitalization cost of patients with acute pancreatitis with or without surgical treatment was significantly different,and the difference was statistically significant?Z=-11.092,P < 0.05?.Hospital expenses of patients with acute pancreatitis of different payment types were significantly different,with statistically significant difference?Z=-9.630,P < 0.05?.5.The composition of hospital expenses This paper studies the individual components of hospital expenses includes: drug expense,laboratory expense,examination expense,operation expense,medical material expense,treatment expense and other expenses,among which drug expense and laboratory expense account for 43.30% and 14.88% respectively.6.The binary logistic regression analysis of hospitalization cost The main influencing factors of hospitalization cost were hospitalization days and operation.The binary logistic regression equation of hospitalization expenses of patients with acute pancreatitis was Y = 2.190X₃-1.554X₄-1.407,?X² = 348.017,P < 0.001?.Conclusion:1.The main factors influencing the severity of acute pancreatitis are age,urea nitrogen,albumin and triglyceride.2.By age,albumin and triglyceride three indicators established new prediction model,has good prediction effect,but as a result of this study is a retrospective study and regional factors are therefore need multicenter,large sample test to confirm.3.The internal composition of hospitalization expenses of patients with acute pancreatitis in Qinghai is unreasonable,mainly including drug expenses and laboratory expenses,and the labor value of medical staff is not fully reflected.4.The main influencing factors of hospitalization expenses of patients with acute pancreatitis in Qinghai area are hospitalization days,surgical treatment or not.Between them,hospitalization days are the most important influencing factors.Reducing hospitalization days can significantly reduce hospitalization expenses.