输尿管软镜钬激光碎石取石术的日间手术与专科住院手术的卫生经济学评价

Comparison of health economical evaluation between ambulatory surgery and special in-hospital surgery mode for flexible ureteroscopic holmium laser lithotriphy for ureteral calculi

目的对日间手术模式进行卫生经济学评价,为外科手术模式的优选和决策提供参照依据。方法选取2015年1月1日—12月31日在中南大学湘雅医院治疗的单侧输尿管软镜下钬激光碎石取石术患者,其中日间手术患者59例(日间组),泌尿结石亚专科住院手术患者65例(专科组)。比较两种手术模式下的平均占用床位时间、成本、治疗效果、满意度的差异。结果日间组与专科组平均占用床位时间分别为(1.03±0.18)、(6.35±0.74)d,差异有统计学意义(P<0.05)。两组均随访1个月,日间组术后并发症有4例(6.8%),专科组术后并发症有4例(6.2%),两组术后并发症发生率差异无统计学意义(P>0.05)。日间组与专科组患者满意度分别为(96.48±0.23)分和(96.53±0.18)分,差异无统计学意义(P>0.05)。日间组与专科组直接医疗成本分别为(17 738.28±1 027.85)、(21 307.67±554.41)元,直接非医疗成本分别为(103.39±18.25)、(630.76±78.90)元,间接成本分别为(266.93±47.12)、(1 640.44±190.55)元,总成本分别为(18 128.10±1 037.76)、(23 558.29±619.20)元,组间差异均有统计学意义(P<0.05)。日间组与专科组治疗效果指数分别为0.96和1.05,成本-效果比分别为18 883.44和22 436.47;进行敏感性分析,调整后的成本-效果比日间组为16 629.64,仍低于专科组的20 534.91。结论日间手术的成本-效果优于专科住院手术模式,患者满意度与专科住院模式无差异,可推荐符合日间手术指征的患者采用该模式。

Objective To evaluate the ambulatory surgery mode by using health economical mothods and provide reference for optimization and decision of surgical operation mode. Methods The patients who underwent unilateral flexible ureteroscopic holmium laser lithotriphy for ureteral calculi in Xiangya Hospital, Central South University between January 1 st to December 31 th, 2015 were selected in this study, including 59 with ambulatory surgery mode（the ambulatory group） and 65 with special in-hospital surgery mode（the special group）. The differences in average bed occupancy time, cost, therapeutic effect, and satisfaction between the two operation modes were compared. Results The average bed occupancy time in the ambulatory group and the special group was（1.03±0.18） and（6.35±0.74） days,respectively, and the difference was statistically significant（P〈0.05）. The patients in both groups were followed up for one month after the operation, and the incidence of complications was 6.8%（4/59） in the ambulatory group and 6.2%（4/65） in the special group, without significant difference（P〉0.05）. The satisfaction score in the ambulatory group and the special group was 96.48±0.23 vs. 96.53±0.18 without significant difference（P〉0.05）. The differences in direct medical cost[（17 738.28±1 027.85） vs.（21 307.67±554.41） yuan], direct non-medical cost [（103.39±18.25） vs.（630.76±78.90） yuan],indirect cost[（266.93±47.12） vs.（1 640.44±190.55） yuan], and total cost [（18 128.10±1 037.76） vs.（23 558.29±619.20）yuan] between the ambulatory group and the special group were all statistically significant（P〈0.05）. The treatment effect index in the ambulatory group and the special group was 0.96 and 1.05, respectively; the cost-effect ratio was 18 883.44 and 22 436.47, respectively. Sensitivity analysis showed that the adjusted cost-effect ratio in the ambulatory group（16 629.64） was still lower than that in the special group（20 534.91）. Conclusions The cost-effect ratio of ambulatory surgery mode is superior than that of special in-hospital surgery mode, and there is no obvious difference in patients satisfaction between the two modes. Ambulatory surgery mode can be recommended to patients who meet the indications of day surgery.