神经外科患者手术部位感染的直接经济损失评价

Evaluation of direct economic losses due to surgical site infections in patients of neurosurgery department

目的探讨神经外科患者手术部位感染(SSI)的直接经济损失,提高医务人员预防控制意识,为医疗机构制定SSI预防控制规章制度提供科学依据。方法监测2013年1月-2014年3月神经外科行手术患者545例,随机选取48例发生与未发生SSI患者,采用1∶1配对方法进行病例对照研究,比较24例SSI患者与同期24例未发生SSI患者的住院天数及住院费用,采用SPSS20.0软件进行统计分析。结果病例组、对照组住院天数中位数分别为30.5d、19.0d,差异有统计学意义(P<0.05);病例组、对照组住院总费用中位数分别为54 824.47元、35 661.97元,差异有统计学意义(P<0.05);而平均每日住院总费用两组比较差异无统计学意义;在分类住院费用中,病例组与对照组中西药费、治疗费、床位费、检验费、护理费比较,差异有统计学意义(P<0.05);神经外科病区每年因SSI少收治了约21例神经外科手术患者,SSI带来的直接经济损失高达71.17万元。结论神经外科手术部位感染带来巨大的经济损失,控制医院感染、保障患者安全、优化医疗资源仍是未来工作的重点。

OBJECTIVE To explore the direct economic losses due to the surgical site infections （SSI） in patients of neurosurgery department and improve the awareness of health care workers on control and prevention so as to provide scientific basis for development of regulations for control of SSI in medical institutions .METHODS A total of 545 patients who underwent the surgery in the neurosurgery department from Jan 2013 to Mar 2014 were monitored ,then 48 patients with or without SSI were randomly included ,the case‐control study was conducted by using 1∶1 matching method ,the length of hospital stay and hospitalization cost were compared between the 24 patients with SSI and the 24 patients without SSI ,and the statistical analysis was performed with the use of SPSS20 .0 software .RESULTS The median length of hospital stay of the case group was 30 .5 days ,the control group 19 .0 days ,and there was significant difference （P〈 0 .05） .The median hospitalization cost of the case group was 54 824 .47 yaun ,the control group 35 661 .97 yuan ,with statistical significance （P〈0 .05） ,while there was no significant difference in the daily total hospitalization cost between the two groups .As for the classified hospitalization cost ,there was significant difference in the cost of western medicine ,treatment cost ,bed cost ,in‐spection cost ,or nursing cost between the case group and the control group （P〈 0 .05） .Approximately 21 pa‐tients were estimated not to be treated in the neurosurgery wards due to SSI ,which brought the direct economic losses up to 7 .117 million yuan .CONCLUSIONS The surgical site infections due to the neurosurgical surgery have brought huge economic losses ,and the efforts remain to be focused on the control of nosocomial infections ,safety of the patients ,and optimization of medical resources .