上海市综合医院骨科高难度手术绩效分析

Study on the Performance of Complicated Orthopedic Surgeries in Comprehensive Hospitals in Shanghai

目的研究上海市级综合性医院体现骨科技术水平的高难度手术绩效。方法采用描述性统计分析、类比分析和专家咨询的方法进行研究。结果经专家评议,上海市18家综合性医院筛选出11种高难度骨科手术,共计4 481例(5.65%);脊柱外科病例最多,为2 121例(47.33%);A医院病例最多,为1 399例,占分析病例的31.22%;按亚专科分类的出院均次费用为42 615~85 770元,平均住院日为6.5~16.36天,术前等待时间差别不大;医院层面的均次费用为36 863~92 001元,药占比为6.94%~21.21%,平均住院日为7.75~23.2天。结论在骨科高难度手术方面,A医院的创伤外科、关节镜外科和关节外科,以及B医院的脊柱外科处于较为领先的地位;各医院手术绩效差异较大,部分医院还有改进空间。

Objective To analyze the performance of complicated orthopedic surgeries in comprehensive hospitals in Shanghai.Methods Methods of questionnaire survey,analogy analysis and expert interviews were adopted for the study.Results A total of 4481 cases in 11 kinds of complicated orthopedic surgeries were selected from 18 comprehensive hospitals,among which spine surgery accounted for 47.33%.Hospital A had a total of 1399 cases,accounted for 31.22%.The average cost per admission was between RMB 42,615 to 85,770 according to sub-discipline; the average length of stay was 6.5 to 16.36 days; and there is little difference in the preoperative waiting days.At the hospital level,the cost per admission ranged from RMB 36,863 to 92,001; the drug proportion was 6.94% to 21.21%; and the average length of stay was 7.75 to 23.2 days.Conclusion In terms of complicated orthopedic surgeries,Hospital A was in a leading position in trauma surgery,joint surgery and arthroscopic surgery,and hospital B was in a leading position in spine surgery.There is a big gap in the performance of complicated orthopedic surgeries between different hospitals and much room for improvement to some hospitals.