阑尾炎手术患者住院费用影响因素通径分析

Path Analysis of Influencing Factors of Hospitalization Cost in Patients undergoing Appendectomy

目的 探讨阑尾炎手术患者住院费用的影响因素,为合理控制医疗费用提供科学依据。方法 收集安徽省6家县级公立医院2164例阑尾炎手术患者的病例信息,运用通径分析方法研究阑尾炎手术患者住院费用的影响因素。结果 患者平均住院天数为5.62天,中位数为5天;平均住院费用为6109.60元,中位数为5511.93元。住院天数是影响住院费用最主要的因素,直接效应为0.544;手术方式、所处地区直接影响住院费用,直接效应为0.101和-0.156;急性单纯性阑尾炎、慢性阑尾炎与术者和助手总人数仅通过住院天数间接影响住院费用,间接效应为-0.138、-0.044和0.055;手术费、麻醉费、转归、年龄、手术操作时间点和其他因素等既可直接影响住院费用,又可通过住院天数间接影响住院费用,总效应分别为0.393、-0.079、0.257、0.257、0.140和0.376。结论 住院天数是影响住院费用的最主要因素,住院费用的控制要以缩短平均住院天数为基础,采取综合措施,加强可控因素的控制,有效控制住院费用的不合理增长。

Objectives To explore the influencing factors of hospitalization cost of patients with appendicitis operation,and provide scientific basis for reasonable control of medical cost.Methods The clinical data of 2164patients undergoing appendicitis surgery from 6 county-level public hospitals in Anhui province were collected.The path analysis method was used to study the influencing factors of hospitalization costs of patients undergoing appendicitis surgery.Results The average length of stay was 5.62 days,with a median of 5 days.The average hospitalization cost was 6109.60 yuan,and the median was 5511.93 yuan.Length of stay was the most important factor affecting hospitalization cost,with a direct effect of 0.544.The method of operation and the location directly affected the hospitalization cost,the direct effect was 0.101 and-0.156.The indirect effects of acute simple appendicitis,chronic appendicitis and total number of surgeons and assistants on hospitalization costs were-0.138,-0.044 and 0.055,respectively.Operation cost,anesthesia cost,outcome,age,operation time point and other factors could directly affect the hospitalization cost,and could indirectly affect the hospitalization cost through the length of stay,the total effect was 0.393,-0.079,0.257,0.257,0.140 and 0.376,respectively.Conclusions The length of stay was the most important factor affecting the hospitalization cost,the control of hospitalization cost should be based on shortening the average length of stay,take comprehensive measures to strengthen the control of controllable factors,and effectively control the unreasonable increase of hospitalization cost.