经鼻蝶窦入路垂体瘤术后颅内感染的经济损失分析

Economic loss due to postoperative intracranial infection in patients undergoing endonasal transsphenoidal surgery for pituitary tumor

目的分析颅内感染对经鼻蝶窦入路垂体瘤患者住院费用和住院天数的影响,为医院感染防控提供卫生经济学支持。方法回顾调查2012年1月-2018年10月神经外科进行经鼻蝶窦入路垂体瘤切除且术后发生颅内感染患者31例,采用1∶1匹配病例对照研究方法纳入31例未发生颅内感染患者,比较两组患者住院费用和住院天数的差异。结果感染组和对照组的中位住院总费用分别为52 756、23 153元,额外经济损失为29 603元,两组差异有统计学意义(Z=-6.624,P=0.001)。分类住院费用中,感染组和对照组护理费、西药费、抗菌药物费、一般治疗操作费、诊断和检查费、耗材费差异均有统计学意义。感染组患者住院天数(中位数)为10天,对照组则为5天,(中位数)增加5天,差异有统计学意义(Z=-5.996,P=0.001)。结论经鼻蝶窦入路垂体瘤术后发生颅内感染不仅延长患者住院天数,还造成显著的经济损失,今后应采取有效管理方法控制相关感染。

OBJECTIVE To observe the influence of intracranial infection on hospitalization cost and length of hospital stay of the patients undergoing endonasal transsphenoidal surgery for pituitary tumor so as to provide health economic support for prevention and control of nosocomial infection. METHODS A total of 31 patients who underwent endonasal transsphenoidal surgery for pituitary tumor in neurosurgery department from Jan 2012 to Oct 2018 and had postoperative intracranial infection were retrospectively investigated, and 31 patients who did not have intracranial infection were included in a 1∶1 ratio by means of case-control method. The hospitalization cost and length of hospital stay were observed and compared between the two groups of patients. RESULTS The median total hospitalization cost of the infection group was 52 756 yuan, the control group 23 153 yuan, with the extra economic loss 29 603 yuan, and there was significant difference between the two groups(Z=-6.624,P=0.001). As compared with the classified hospitalization costs, there were significant differences in nursing cost, western medicine cost, cost of antibiotics, general treatment cost, cost of diagnosis and treatment and cost of consumable items between the infection group and the control group. The median length of hospital stay of the infection group was 10 day, the control group 5 days, with the increase(median) 5 days, and there was significant difference(Z=-5.996,P=0.001). CONCLUSION The postoperative intracranial infection may not only extend the length of hospital stay of the patients undergoing endonasal transsphenoidal surgery for pituitary tumor but also result in the economic loss, and it is necessary to take effective measures for control of the infection.