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12.09.2018

Impaired activity of daily living is a risk factor for high medical cost in patients of non-variceal upper gastrointestinal bleeding

Zeitschrift:
Surgical Endoscopy
Autoren:
Yusaku Takatori, Motohiko Kato, Yukie Sunata, Yuichiro Hirai, Yoko Kubosawa, Keichiro Abe, Yoshiaki Takada, Tetsu Hirata, Shigeo Banno, Michiko Wada, Satoshi Kinoshita, Hideki Mori, Kaoru Takabayashi, Miho Kikuchi, Masahiro Kikuchi, Masayuki Suzuki, Toshio Uraoka

Abstract

Background

Non-variceal upper gastrointestinal bleeding (NVUGIB) is still a common and life-threatening disease, thus it would have a big impact on medical care cost. However, little is known about risk factors for increased medical care cost in NVUGIB patients.

Aim

The purpose of the study was to clarify predictor of requiring high medical care cost in NVUGIB patients. Patients who underwent endoscopic hemostasis due to NVUGIB between April 2012 and March 2015 were included in this retrospective study. We analyzed the association between patients’ background including activity of daily livings (ADL) and high medical care cost using logistic regression model. Medical care cost was calculated in reference to the “Diagnosis Procedure Combination” which is diagnosis-dominant case-mix system in Japan. The cutoff value of high medical care cost was defined as its first quartile. ADL was assessed according to Katz-6 score. We defined impaired ADL patient who revealed Katz-6 score more than 1.

Results

A total of 128 consecutive patients were included in this study. Median medical care cost was 5323 USD (IQR 3661–8172 USD). There were 13 patients (10%) in impaired ADL group. In univariate analysis, age and impaired ADL before admission revealed significant association with high cost. Of these, impaired ADL was an only independent risk factor [odds ratio 15.3 (95% CI 2.49–183)] in multivariate analysis.

Conclusion

Impairment in ADL before admission was an independent predictor for high medical care cost with NVUGIB patients.

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