手术部位感染致直接经济损失1∶1病例对照研究

The 1∶1case-control study on direct economic loss due to surgical site infection

目的从卫生经济学角度探讨手术部位感染(SSI)的直接经济损失,为卫生行政部门制订决策提供依据。方法调取2008年3月—2010年2月某院乳腺、胃、结肠和直肠SSI病例,采用病例对照研究的方法,按照条件相似的原则1∶1配对,SSI者为SSI组,对照组为同期手术未发生SSI的患者,比较SSI组与对照组住院费用和住院日数差异,评价SSI的经济损失。结果共调查手术病例1 523例,发生SSI 75例,SSI发病率4.92%。按配对原则获得有效配对69对,经配对样本的秩和检验,SSI组与对照组的住院费用比较,差异有统计学意义(Z=6.586,P<0.001),SSI组患者住院费用中位数比对照组高6 828.60元,SSI组各项费用均高于对照组;SSI组患者住院日数中位数比对照组延长10 d,两组差异有统计学意义(Z=5.939,P<0.001)。结论 SSI延长患者住院日数,增加医疗费用的支出,同时降低病床周转率,影响经济收入和医疗质量。

Objective To evaluate the direct economic loss due to surgical site infection（SSI）from a medical economics perspective,and provide basis for health administrative departments to make strategies.Methods SSI in patients undergoing breast,stomach and colorectal operation between March2008 and February2010 were selected for1∶1 case-control study,patients with SSI were as SSI group,without SSI during the same period were as control group,difference in medical expense and length of stay between two groups were compared,economic loss due to SSI was evaluated.Results A total of 1 523 operation cases were investigated,75（4.92%）developed SSI.69 effective pairings were obtained.Wilcoxon signed rank test revealed that difference in medical expense between two groups was statistically significant（Z=6.586,P0.001）,the median of average medical expense of SSI group was6 828.60 yuan higher than control group,all kinds of medical expense in SSI group were all higher than control group;the median length of stay of SSI group was 10 days longer than that of control group（Z=5.939,P0.001）.Conclusion SSI can prolong hospitalization,increase medical expense,decrease bed turnover rate,and influence economic income and medical quality.