小儿隐睾日间手术与专科住院手术卫生经济学评价

Comparison of health economics evaluation between day surgery and special in-hospital surgery mode for the treatment of cryptorchidism in children

目的对日间手术模式和传统专科住院手术模式在卫生经济学方面进行评价,为小儿腹股沟型隐睾选择不同的住院治疗模式提供参考。方法收集重庆医科大学附属儿童医院2017年1月-2018年1月间年龄小于5岁的单侧腹股沟型隐睾患儿的临床资料,将纳入患儿依据不同住院手术模式分为日间手术组(日间组)和专科住院手术(专科组)。比较两种手术模式下患儿的一般资料、术后并发症、萎缩率、上缩复发、院内感染等治疗效果指标,患者满意度、占用床位时间、住院费用等卫生经济学指标,分析两种住院手术模式的成本-效果。结果共纳入患儿198例。其中,日间组83例,专科组115例。两组患儿均采用经腹股沟皮纹小切口+阴囊切口行睾丸固定术治疗。两组患儿的患侧、来源地域、术后并发症、院内感染情况比较,差异均无统计学意义(P>0.05)。专科组与日间组比较,年龄较大[(27.60±11.04)vs.(20.88±9.48)个月;t=4.586,P<0.001],占用床位时间[(118.60±10.80)vs.(23.95±5.90)h;t=72.353,P<0.001]和手术时间[(0.45±0.15)vs.(0.38±0.12)h;t=2.946,P=0.004]均较长。日间组92.8%的患儿住院费用<5 000元,而专科组95.7%的患儿住院费用≥5 000元,两组比较差异有统计学意义(χ^2=155.374,P<0.001)。麻醉评估分级专科组更高(χ^2=44.870,P<0.001)。日间组与专科组治疗效果指数分别为0.99和1.01,成本-效果比分别为3 850和6 657,日间组经济学效益更好。结论日间手术收治模式的成本-效果优于专科住院模式,对符合日间手术收治指征的患儿推荐采用该模式,患儿享有更佳的经济学效益。

Objective To evaluate the health economics indexes of day surgery mode and traditional specialist hospitalization mode, and to provide reference for the selection of different hospitalization mode of inguinal-type cryptorchidism in children. Methods The patients with unilateral cryptorchidism under 5 years old between January2017 and January 2018 in Chongqing Children’s Hospital were selected in this study. According to different inpatient surgery modes, the included children were divided into day surgery group(day group) and special in-hospital surgery group(specialty group). The general data of patients, treatment indicators, incidence of complications, postoperative testicular atrophy rate, recurrence, nosocomial infection, hospitalization time, hospitalization cost, satisfaction of patients,and other health effect indicators between the two operation modes were compared. The treatment effect indexes and cost-effect ratio of the two modes were statistically analyzed. Results A total of 198 children were included, including 83 in the day group and 115 in the specialty group. The patients in both groups underwent orchiopexy by small inguinal dermatoglyph and scrotal incision. There was no statistically significant difference in the affected side, source area,postoperative complications, or nosocomial infection between the two groups(P>0.05). The patients in the specialty group were older than those in the day group [(27.60±11.04) vs.(20.88±9.48) months old;t=4.586, P<0.001];the bed occupancy time [(118.60±10.80) vs.(23.95±5.90) h;t=72.353, P<0.001] and operation time [(0.45±0.15) vs.(0.38±0.12) h;t=2.946,P=0.004] in the specialty group were longer than those in the day group. The difference was statistically significant in hospitalization expenses between the two groups(χ^2=155.374, P<0.001);92.8% of the children in the day group spent less than 5 000 yuan, while 95.7% of the children in the specialty group spent more than 5 000 yuan. The American Society of Anesthesiologists scores in the specialty group were higher than those in the day group(χ^2=44.870, P<0.001). The treatment effect indexes in the day group and the specialty group were 0.99 and 1.01, respectively, and the cost-effect ratios were 3 850 and 6 657, respectively. The economic benefit of the day group was better. Conclusions The costeffectiveness of day surgery is better than that of specialized inpatient surgery. Therefore, this model can be recommended for children who meet the indications of day surgery.