加速康复外科在肝细胞癌肝切除术患者中的应用效果与费用分析

Effectiveness and cost analysis of enhanced recovery after surgery in patients underwent radical resection of hepatocellular carcinoma

目的分析对肝细胞癌根治性切除术患者应用加速康复外科(EARS)模式的临床效果和费用。方法根据纳入和排除标准,回顾性收集2017年1月至2019年12月期间在四川大学华西医院行肝细胞癌根治性切除术的成年患者的临床病理资料。结果本研究共收集到1082例患者,其中ERAS组469例,传统组613例,2组患者在基线资料如性别、年龄、体质量指数、术前合并症、手术类型及医疗组方面比较差异均无统计学意义(P>0.05)。与传统组比较,ERAS组总住院费用、医疗服务费、检查费、床位费、冷暖费更低(P<0.05),平均总住院时间缩短约1.2 d(P<0.01)、术前住院时间缩短约0.3 d(P=0.03)、术后住院时间缩短约0.8 d(P<0.01)。2组患者间术后各项并发症发生率及总并发症发生率比较差异均无统计学意义(P>0.05)。结论ERAS模式能够在不增加并发症的基础上有效改善肝细胞癌肝切除术患者的康复效果,降低肝细胞癌肝切除术患者的总住院费用。

Objective To analyze the clinical effects and hospitalization costs of the enhanced recovery after surgery(ERAS)mode for patients underwent radical resection of hepatocellular carcinoma(HCC).Method The clinicopathologic data of adult patients who underwent radical resection of HCC in the West China Hospital of Sichuan University from January 2017 to December 2019 were collected retrospectively.Results A total of 1082 patients were collected according to inclusion and exclusion criteria in this study,including 469 patients in the ERAS mode group and 613 patients in the traditional mode group.There were no significant differences in baseline data such as gender,age,body mass index,preoperative complications,operation type,and medical group between the two groups(P>0.05).Compared with the traditional mode group,the total hospitalization cost,medical service fee,examination fee,bed fee,and cooling and heating fee in the ERAS mode group were lower(P<0.05),the average total hospitalization time was shortened by about 1.2 d(P<0.01),the preoperative hospitalization time was shortened by about 0.3 d(P=0.03),and the postoperative hospitalization time was shortened by about 0.8 d(P<0.01)in the EARS mode group.There were no significant differences in the incidences of specific complications and total complications between the two groups(P>0.05).Conclusion ERAS for patients with HCC might play a role in improving rehabilitation efficiency and reducing hospitalization costs.