单中心手术治疗垂体腺瘤的卫生经济学初步研究

Health economic evaluation of surgical treatment of pituitary adenomas in a single center

目的分析单中心垂体腺瘤手术治疗概况,为提高疗效、合理配置和高效利用现有医疗资源提供依据。方法回顾性分析6750名行手术治疗并有明确病理学诊断的垂体腺瘤病例资料。比较病人年龄、性别、围手术期病死率,以及医改相关的卫生经济学指标(住院时间、住院费用)。结果垂体腺瘤病人男、女比例1∶1.1。初次手术时,男、女平均年龄分别为(45.8±12.9)岁和(44.7±12.8)岁,差异有统计学意义(P<0.05)。垂体腺瘤年手术量逐年增加,2014年达1159台,7年内总的住院期间病死率为0.22%。病人住院费用中位数为21970.5元,医改后住院费用和住院日均较医改前减少(P<0.05),2014年住院费达最低水平。经蝶手术治疗费用少于开颅手术(P<0.05)。住院期间死亡病人的住院日和住院费用均超过未死亡病人(P<0.05)。总住院日和术后住院日分别与住院费呈正相关关系。结论天坛医院手术治疗的垂体腺瘤病人数量逐年增多,人均住院费用和住院日下降。开颅手术与经蝶手术相比,需要更多的住院费用和更长住院日。良好手术效果可节约医疗资源。医改措施的开展有利于资源利用率的提高。

Objective To analyze the outcome of surgical treatment of pituitary adenoma in a single center, which may be helpful in improving the treatment efficacy and adjusting health resources. Methods The clinical data of 6750 patients receiving surgery for pituitary adenoma, whose diagnoses were confirmed by pathological examination, were analyzed retrospectively. The age and gender of patients, perioperative mortality, and indicators of health economics related to health care reform（the hospital cost and length of stay）were compared. Results The ratio of male to female patients was 1 to 1.1. The average age was 45.8 ± 12.9 years old and 44.7 ± 12.8years old in male and female patients respectively when they were treated first time（P〈0.05）. The number of pituitary tumor surgery increased year by year, which was 1159 cases in 2014. The total mortality rate was 0.22% during the seven years. The median hospital costs was $21970.5. Hospital costs and length of stay were shortened after the medical reforms were adopted（P〈0.05）. Hospital costs was at the lowest level in 2014. The costs of transsphenoidal surgeries were less than those of craniotomy surgeries（P〈0.05）. The costs and hospital length of stay of the patients who died during hospital were more than those of patients who were alive when discharged（P〈0.05）. Total length and postoperative length of hospital stay were positive correlation with hospital costs respectively. Conclusions The amount of pituitary adenoma surgery is increasing year by year in Tiantan Hospital, while the hospital cost and length of stay is decreasing. Craniotomy costs more medical resources and needs more hospital days compared with transphenoidal surgery. Good therapeutic effect saves medical resources. The medical reforms improve the hospital costs and length of hospital stay.