小儿腹股沟斜疝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 day surgery and inpatient hospitalization surgery mode for inguinal hernia

目的对小儿日间手术模式和专科住院手术模式的卫生经济学进行评价,为小儿腹股沟斜疝手术的优选和决策提供参照依据。方法收集2016年6月至2017年7月间所有在重庆医科大学附属儿童医院治疗且符合纳入标准的单侧腹股沟斜疝患儿的临床资料,其中日间手术患儿324例(日间组),专科住院手术患儿65例(专科组)。比较两种手术模式下的患儿一般资料、治疗指标、容错情况、术后需要留院处理的并发症发生率、复发率、院内的感染等卫生效果指标;比较两种模式的HCAHPS优化星表满意度、住院时间、住院费用等卫生经济学指标。统计分析两种模式的成本-效果:治疗效果权重W、治疗效果指数(EI)、成本-效果比(CER)。结果日间外科组和专科组在性别、区域方面的差异无统计学意义,专科组年龄分布更广。日间组与专科组占用床位时间分别为(23.17±0.49)h和(112.06±19.75)h,差异具有统计学意义(P<0.01);两组的医疗费用分别为(3372±430)元和(6063±2104)元,差异具有统计学意义(P<0.01)。两组麻醉分级ASA比例的差异具有统计学意义,两组术后并发症发生率的差异无统计学意义(P>0.05)。日间组与专科组治疗EI分别为0.98和1.02,CER分别为3305和6184,日间组经济学效益较大。结论日间手术的成本-效果优于专科住院手术模式,患儿满意度和术后复发率与专科住院模式的差异无统计学意义,推荐符合日间手术指征的患儿采用该模式。

Objective To evaluate the day surgery mode of children and inpatient hospitalization surgery mode by using health economical methods and provide reference for optimization and decision of children indirect inguinal hernia operated.Methods Clinical data were collected from 389 children of uninterrupted unilateral indirect inguinal hernia from June 2016 to July 2017.Two modes were day surgery(day group,n=324)and inpatient hospitalization surgery(special group,n=65).The inter-group differences in general patient data,treatment index,fault tolerance,incidence of postoperative complications,recurrence rate and hospital infection were compared.And the inter-group differences in Hospital Consumer Assessment of Healthcare Providers and Systems Survey satisfaction,hospitalization stay,hospitalization cost and other health economic indicators were compared.The cost-effect of two modes was analyzed statistically,including weight of therapeutic effect W,treatment effect index of EI and cost-effect ratio CER.Results No inter-group statistical difference existed in gender or region.However,age distribution was wider in special group.The average bed occupancy time in day and inpatient groups was(23.17±0.49)and(112.06±19.75)hours respectively and the differences was statistically significant(P<0.01).And the hospitalization expenditure was(3372±430)and(6063±2104)yuan in day and special groups and the differences was statistically significant(P<0.01).The inter-group differences were statistically significant in the proportion of anesthetic grade ASA.And the incidence of complications showed no significant inter-group differences.In day and inpatient groups,the treatment effect index was 0.98 and 1.02 and the cost-effect ratio 3305 and 6184 respectively.Thus the economic benefits were greater in day group.Conclusions The cost-effect ratio of day surgery mode is superior to that of inpatient hospitalization surgery mode.No obvious differences exist in patient satisfaction or postoperative recurrence rate.Day surgery mode may be recommended for children with the indications of day surgery.