非急诊手术合并2型糖尿病患者住院费用影响因素分析

A multifactor analysis for hospitalization expense in patients with type 2 diabetes mellitus undergoing non-emergency surgery

目的 分析行非急诊手术合并2型糖尿病患者住院费用的影响因素.方法 回顾性调查2013年1月1日至2013年12月31日本院行非急诊手术患者的住院病历资料,糖尿病组109例,条件匹配的162例非糖尿病患者为对照组.比较两组住院费用等指标,对糖尿病组住院费用影响因素进行多重线性回归分析.结果 糖尿病组中位住院费用为12 014.74元,是对照组9698.54元的1.24倍（P=0.001）.与对照组相比,糖尿病组麻醉分级、伤口愈合时间、术后感染率、住院时间均明显升高（P＜0.01）;麻醉分级（β=0.442,P=0.000）、术后1周空腹血糖（β=0.204,P=0.020）、术后感染（β=0.204,P=0.019）是糖尿病组住院费用的主要影响因素;在微创手术情况下,糖尿病组与对照组术后感染率、住院费用差异无统计学意义（P＞0.05）.结论 非急诊手术合并2型糖尿病患者的住院费用高,麻醉分级、术后1周空腹血糖、术后感染是其主要影响因素.优先选择微创手术、规范围手术期血糖管理将有助于减少糖尿病患者住院费用。

Objective To investigate the factors of hospitalization expense in patients with type 2 diabetes mellitus undergoing non-emergency surgery.Methods A retrospective study included diabetic （109 cases） and control （162 cases） groups.Hospitalization expense and other observation indices were compared between two groups and subgroups.The factors that contribute to hospitalization expense were analyzed with multifactor regression analysis model.Results The median hospitalization expense was 12 014.74 yuan in the diabetic group,1.24 times than that in the control group （P =0.001）.Diabetic group has higher American Society of Anesthesiologists （ASA） classification,longer wound healing time,higher postoperative infection rate,and longer hospital stay （P 〈 0.01）.Multifactor analysis revealed that the significant factors that influence the hospitalization expense were ASA classification （β =0.442,P =0.000）,postoperative fasting plasma glucose （β =0.204,P =0.020）,and postoperative infection （β =0.204,P =0.019）.No significant difference was found in postoperative infection rate and hospitalization expense between two groups,when patients had received minimally invasive surgeries （P 〉 0.05）.Conclusions Type 2 diabetes patients have higher hospitalization expense;ASA classification,postoperative fasting plasma glucose,and postoperative infection are the main influence factors.Giving priority to minimally invasive surgeries and enhancing perioperative glucose control can help to reduce hospitalization expense in patients with type 2 diabetes mellitus.