甲状腺癌手术患者住院费用影响因素与结构关联分析

Analysis of Influencing Factors and Structure of Hospitalization Expenses in Patients with Thyroid Cancer Surgery

目的:探究甲状腺癌手术患者住院费用的影响因素及结构特征,为费用控制提供参考。方法:选取川南地区某三级甲等医院出院时间为2019年1月1日至2021年12月31日甲状腺癌手术患者住院数据,采用多元逐步回归探究其费用的外部影响因素,采用广义灰色关联分析法研究总费用与各单项费用之间的结构关联度以探索其内部影响因素。结果:共得到2327例甲状腺癌手术患者,多元回归分析结果显示,手术切除方式(双侧、单侧、部分切除)、住院天数、是否并发症手术、是否甲状旁腺移植、是否伴并发症以及病理类型是影响其住院费用的主要因素(P<0.05),其中手术切除方式(b=0.329)和住院天数(b=0.304)对费用的影响作用最为明显。费用结构中,治疗费和材料费占比最高,合计超过60%,综合医疗服务费占比偏低(6.5%);结构关联分析显示治疗费(0.9790)和材料费(0.8589)与总费用的综合关联度靠前,综合医疗服务费的关联度最低(0.7436)。结论:手术切除方式和住院天数是甲状腺癌手术患者住院费用的主要外部影响因素,治疗费和材料费是其主要内部影响因素,费用结构有待优化。

Objective:To explore the influencing factors and structural characteristics of hospitalization expenses of patients with thyroid cancer surgery,and provide reference for cost control.Methods:The data of patients with thyroid cancer who were discharged from a certain grade A tertiary hospital in southern Sichuan from January 1,2019 to December 31,2021 were selected to explore the external influencing factors of their costs by multiple stepwise regression,and the structural correlation between the total costs and individual costs was studied by generalized grey correlation analysis to explore the internal influencing factors.Results:A total of 2,327 patients with thyroid cancer underwent surgery were obtained.The results of multiple regression analysis showed that the main factors affecting the hospital expenses were the surgical resection method(bilateral,unilateral,partial resection),the length of hospital stay,whether there a complication of surgery,whether parathyroid gland transplantation,whether there were complications and pathological type(P<0.05),Among them,the effect of surgical resection method(β=0.329)and hospital stay(β=0.304)on the cost is the most obvious.In the cost structure,the treatment fee and material fee account for the highest proportion,more than 60%in total,and the comprehensive medical service fee accounts for a low proportion(6.5%);The structural correlation analysis showed that the comprehensive correlation between the treatment cost(0.9790)and the material cost(0.8589)and the total cost was the highest,and the comprehensive medical service cost was the lowest(0.7436).Conclusion:The surgical resection mode and the length of stay are the main external influencing factors of the hospitalization expenses of patients with thyroid cancer surgery.The treatment cost and material cost are the main internal influencing factors.The cost structure needs to be optimized.