Toplumdan Kökenli Pnömoni Nedeniyle Hastanede Yatan Yaşlı Hastaların (> 65 Yaş) Özellikleri ve Ekonomik Yükü

Year 2022, , 84 - 91, 29.04.2022

Nuran Katgı , Pınar Çimen Aysu Ayrancı , Fevziye Fatma Tuksavul

https://doi.org/10.47493/abantmedj.969524

Abstract

Amaç: Toplum kökenli pnömoni (TKP) nedeniyle yaşlı hastaların hastane yatış sıklığı yüksektir ve hastane maliyetini arttırır. TKP nedeniyle hastanede yatan yaşlı hastaların (>65 yaş) özellikleri ve maliyeti analiz edildi.

Gereç ve Yöntemler: 01.01.2015-15.11.2017 tarihleri arasında pnömoni nedeniyle hastanede yatan 180 hastanın retrospektif analizi yapıldı. TKP nedeniyle hastanede yatan 65 yaş üstü hastalar yatış gününden itibaren 30 güne kadar mortalite için takip edildi. Taburcu olanlar ise 90 güne kadar takip edildi. Hastane maliyeti analiz edildi.

Bulgular: 115 (%60) hasta 65 yaş üstüydü. Hastaların %82.4'üne oksijen tedavisi, %27.8'ine noninvaziv mekanik destek uygulandı. %16.5 hastada yoğun bakım desteğine gerek duyuldu. Pnömoni ciddiyet indeksi (PCİ) yaşla birlikte arttı (p=0.021). Otuz günlük mortalite oranı artmış yaşla ilişkiliydi (p=0.048). Toplam tedavi maliyetinin yüksek PCİ ile arttığı izlendi (p=0.003). Yüksek PCİ ve toplam maliyet özellikle mortalite ile ilişkiliydi (p=0.000). Otuz günlük mortalite oranı ileri yaşla ilişkili bulunurken (p=0.048) 60 ve 90 günlük mortalite oranlarında bu ilişki gösterilemedi (p=0.244, p==0.469). 30 günlük mortalite oranı kronik obstrüktif akciğer hastalığı (KOAH) ve malignitesi olanlarda yüksekti (p=0.038, p=0.040). Hastane maliyeti ve ek hastalıklar arasında bir ilişki bulunamadı (p>0.05).

Sonuç: TKP yaşlı hastalarda yaygın bir hastane yatış nedenidir. Yaşlı hastalarda TKP yüksek ölüm oranı ve artmış tedavi maliyeti nedeniyle daha önemlidir. Erken ve yeterli tedavi için risk faktörü olan yaşlı hastaların tespiti önemlidir.

Keywords

yaşlı, hastane yatışı, toplum kökenli pnömoni, maliyet

Characteristics and Economic Burden of Hospitalized Elderly Patients (> 65 Years) Due to Community-Acquired Pneumonia

Abstract

Objective: The prevalence hospitalization of elderly patients due to community acquired pneumonia (CAP) is high and increases the hospital cost. Characteristics and economic burden of hospitalized elderly patients (>65years) due to CAP were analyzed.

Materials and Methods: We performed a retrospective analysis of the 180 patients who were hospitalized with pneumonia between 01.01.2015-15.11.2017. Patients older than 65 years old and hospitalized for CAP were followed up for up to 30 days from initial hospitalization for mortality and the patients who were discharged were followed up to 90 days of initial hospitalization. Hospital costs were analyzed.

Results: 115(60%) patients were older than 65. 82.4% of the patients received oxygen therapy and 27.8% of them received noninvasive mechanical support. 16.5% of the patients needed intensive care support. PSI was increased with age(p=0.021). Thirty-day mortality was related with older age(p=0.048). Total treatment costs were increased with high PSI (p=0.003). Increased PSI and total cost were significantly associated with mortality (p=0.000). Thirty-day mortality was related with older age(p=0.048), but age was not related with 60-day and 90-day mortality (p=0.244, p=0.469). 30-day mortality was high in patients with COPD and malignancy (p=0.038, p=0.040). No associations were found between total hospital cost and additional diseases (p>0.05).

Conclusion: CAP is a common cause of hospitalization in elderly patients. Older patients had more severe CAP which caused high mortality and high treatment costs; so it is important to identify elderly patients with risk factors for early adequate treatment.

Keywords

Elderly, hospitalization, community acquired pneumonia, cost

References

• Referans 1. Egger ME, Myers JA, Arnold FW, Pass LA, Ramirez JA, Brock GN. Cost effectiveness of adherence to IDSA/ATS guidelines in elderly patients hospitalized for Community-Aquired Pneumonia. BioMed Central Medical Informatics and Decision Making 2016 Mar 15;16:34. doi: 10.1186/s12911-016-0270-y
• Referans 2. Chen L, Zhou F, Li H, Xing X, Han X, Wang Y, et al. Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey. British Medical Journal Open 2018 Feb 15;8(2):e018709. doi: 10.1136/bmjopen-2017-018709.
• Referans 3. Almirall J, Bolíbar I, Vidal J, Sauca G, Coll P, Niklasson B, et al. Epidemiology of community-acquired pneumonia in adults: a population-based study. European Respiratory Journal 2000 Apr;15(4):757-63. doi: 10.1034/j.1399-3003.2000.15d21.x.
• Referans 4. Cilloniz C, Rodrigues-Hurtado D, Torres A. Characteristics and management of community-acquired pneumonia in the era of global aging. Medical Science 2018, 6(2):35. doi: 10.3390/medsci6020035.
• Referans 5. World Population Prospects: The 2017 Revision I Multimedia Library- United Nations Department of Economic and Social Affairs. Available online: https://www.un.org/development/desa7publications/world-population-prospects-the-2017-revision.html(accessed on 9 February 2018).
• Referans 6. Konomura K, Nagai H, Akazawa M. Economic burden of community-acquired pneumonia among elderly patients: a Japanese perspective. Pneumonia (Nathan). 2017 Dec 5;9:19. doi: 10.1186/s41479-017-0042-1.
• Referans 7. Brown JD, Harnett J, Chambers R, Sato R. The relative burden of community-acquired pneumonia hospitalizations in older adults: a retrospective observational study in the United States. BioMed Central Geriatrics. 2018 Apr 16;18(1):92. doi: 10.1186/s12877-018-0787-2.
• Referans 8. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Şarkıcı DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. The New England Journal of Medicine 1997 Jan 23;336(4):243-50. doi: 10.1056/NEJM199701233360402.
• Referans 9. Sato R, Gomez Rey G, Nelson S, Pinsky B. Community-acquired pneumonia episode costs by age and risk in commercially insured US adults aged ≥50 years. Applied Health Economics and Health Policy 2013 Jun;11(3):251-8. doi: 10.1007/s40258-013-0026-0.
• Referans 10. File TM Jr, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgraduate Medicine 2010 Mar;122(2):130-41. doi:: 10.3810/pgm.2010.03.2130.
• Referans 11. Campling J, Jones D, Chalmers JD, Jiang Q, Vyse A, Madhava H, et al. The impact of certain underlying comorbidities on the risk of developing hospitalised Pneumonia in England. Pneumonia (Nathan). 2019 Oct 11;11:4. doi: 10.1186/s41479-019-0063-z.
• Referans 12. Han X, Zhou F, Li H, Xing X, Chen L, Wang Y, et al. Effects of Age, Comorbidity and Adherence to Current Antimicrobial Guidelines on Mortality in Hospitalized Elderly Patients With Community-Acquired Pneumonia. BioMed Central Infectious Diseases 2018 Apr 24;18(1):192. doi: 10.1186/s12879-018-3098-5.
• Referans 13. Calle A, Marquez MA, Arellano M, Perez LM, Pi-Figueras M, Miralles R. Geriatric Assessment and Prognostic Factors of Mortality in Very Elderly Patients With Community-Acquired Pneumonia. Archivos de Bronconeumologia.2014;50(10):429-434. doi: 10.1016/j.arbres.2014.01.012.
• Referans 14. Kim MA, Park JS, Lee CW, Choi WII. Pneumonia Severity Index in Viral Community Acquired Pneumonia in Adults. PLoS One 2019 Mar 6;14(3). doi: 10.1371/journal.pone.0210102.
• Referans 15. Viasus D, Cillóniz C, Cardozo CG, Puerta P, Garavito A, Torres A, et al. Early, short and long-term mortality in community-acquired pneumonia. Annals of Research Hospitals 2018;2:5 doi: 10.21037/arh.2018.04.02.
• Referans 16. Huang SS, Johnson KM, Ray GT, Wroe P, Lieu TA, Moore MR, et al. Healthcare utilization and cost of pneumococcal disease in the United States. Vaccine 2011 Apr 18;29(18):3398-412. doi: 10.1016/j.vaccine.2011.02.088.
• Referans 17. Choudhury G, Chalmers JD, Mandal P, Akram AR, Murray MP, Kısa P, et al. Physician Judgement Is a Crucial Adjunct to Pneumonia Severity Scores in Low-Risk Patients. European Respiratory Journal 2011 Sep;38(3):643-8. doi: 10.1183/09031936.00172910.
• Referans 18. Ma HM, Tang WH, Woo J. Predictors of in-hospital mortality of older patients admitted for community-acquired pneumonia. Age and Ageing 2011 July;40(6):736-41. doi: 10.1093/ageing/afr087.
• Referans 19. Dai RX, Kong QH, Mao B, Xu W, Tao RJ, Wang XR, et al. The mortality risk factor of community acquired pneumonia patients with chronic obstructive pulmonary disease: A retrospective cohort study. BioMed Central Dec 2018;18(1). doi: 10.1186/s12890-018-0587-7.
• Referans 20. Stupka JE, Mortensen EM, Anzueto A, Restrepo MI. Community-acquired pneumonia in elderly patients. Aging health. 2009; 5(6): 763–774. doi:10.2217/ahe.09.74.
• Referans 21. Hu G, Zhou Y, Wu Y, Yu Y, Liang W, Ran P. The Pneumonia Severity Index as a Predictor of In-Hospital Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. PLoS ONE July 2015;10(7). doi:10.1371/journal.pone.0133160.
• Referans 22. Olasupo O, Xiao H, Brown JD. Relative Clinical and Cost Burden of Community-Acquired Pneumonia Hospitalizations in Older Adults in the United States—A Cross-Sectional Analysis. Vaccines (Basel) 2018 Sep; 6(3): 59. doi:10.3390/vaccines6030059.