临床路径管理模式下成人腹股沟疝日间手术应用研究

Clinical pathway management on daytime surgery of adult patients with inguinal hernia

目的探讨成人腹股沟疝日间手术临床路径的实施及应用效果。方法收集2014年1月至2016年6月聊城市人民医院收治的120例成人单侧腹股沟疝患者的临床资料,按照患者意愿分为临床路径组(观察组)56例和住院手术组(对照组)64例,分析两组患者住院时间、住院费用、手术效果及术后并发症等情况,并进一步做成本-效果分析。结果两组患者的手术时间、术中出血量、术后并发症发生率等指标比较,差异无统计学意义(t=0.397、0.790,P=0.823、0.430;χ^2=0.250,P=0.617);观察组患者的住院时间及住院总费用均显著低于对照组(t=10.851、6.755,均P<0.001)。成本-效果分析显示观察组患者每减少1例术后并发症,需要消耗的社会成本均低于对照组。结论应用临床路径管理模式能够显著降低成人腹股沟疝患者住院医疗成本,在提高效率的同时最大程度地降低医疗风险,保障日间手术的安全,提高医疗质量。

Objective To analyze the effect of clinical pathway management on daytime surgery of adult patients with inguinal hernia. Methods Based on the application of clinical pathway, one hundred and twenty patients with unilateral inguinal hernia were recruited in Liaocheng People’s Hospital from January 2014 to June 2016, and were divided into clinical pathway group(observation group) with 56 cases and inpatient surgery group(control group) with 64 cases according to patients’ opinion. The length of stay, costs, surgical effect, postoperative complications and cost-effectiveness analysis were compared.Results There were no significant differences between the two groups in operation time, blood loss during the operation, or postoperative complications(t=0.397, 0.790, P=0.823, 0.430;χ^2=0.250, P=0.617).Compared with the control group, the length of stay and costs were shorter in the observation group(t=10.851,6.755, both P<0.001), and cost-effects were lower. Conclusion The clinical pathway management can significantly reduce the costs of stay, improve the efficiency with minimized medical risk and ensure the medical safety and quality.