1408例腹腔镜胆囊切除临床路径成效分析

Analysis of the effect of laparoscopic cholecystectomy clinical pathway for 1408 cases

回顾性分析研究2006年1月1日至2010年12月31日住院行腹腔镜胆囊切除的全部病例,以此来分析北京某三级甲等医院的腹腔镜胆囊切除临床路径的实施效果。按照临床路径入选标准筛选病例,建立具有可比性的"路径前组"和"路径完成组"。该临床路径包括多种胆囊良性疾病和合并症,无年龄限制。比较临床路径实施前后的差异,无死亡病例。在治愈率、好转率、非计划再入院率、非计划再手术率、患者满意度等方面,两组间无显著性差异。路径前组1030例,路径完成组1408例,后者平均住院日短于前者(P<0.001)。路径完成组次均费用略高于路径前组,但住院费用的比例更加趋向合理。腹腔镜胆囊切除临床路径可以在保证医疗质量的前提下,促使平均住院日缩短,住院费用的结构更加合理。

Analysis of the effect of laparoscopic cholecystectomy clinical pathway in a tertiary medical centers in Beijing.Retrospectively study all inpatient laparoscopic cholecystectomy cases from January 1,2006 to December 31,2010.The screening criteria was in accordance with the clinical pathway.The clinical pathway includes a variety of benign gallbladder disease and complications,no age limit.Compare the differences of the clinical pathway before and after.No deaths occurred.No significant difference between the two groups about the cure rate,improvement rate of unplanned re-admission rates,unplanned re-operation rate,patient satisfaction and other aspects.The average length of stay of 1408 cases which completed the pathway was shorter than the group of 1030 cases before the pathway（p 0.001）.Completed pathway group costed slightly higher than the group before pathway.However,the proportion of hospital costs tended to be more reasonable.Laparoscopic cholecystectomy clinical pathway with ensuring the quality of medical care can make the average length of stay significantly shorter and hospital fees structure more reasonable.