基于倾向指数匹配法的日间腹腔镜下儿童腹股沟斜疝疝囊高位结扎术的效果评价

Effect evaluation of high ligation of hernia sac in children with oblique inguinal hernia under day laparoscope based on propensity index matching method

目的基于倾向指数匹配法评价日间腹腔镜下儿童腹股沟斜疝疝囊高位结扎术的实施效果。方法收集该院出院时间为2019年1月1日至2021年12月31日的2789例腹股沟斜疝病种患儿的病案首页数据,根据手术模式的不同,将实施日间手术模式的患儿作为日间组(766例),普通专科住院手术模式患儿作为专科组(2023例),以1∶1比例采用倾向性评分匹配方法均衡两组混杂因素,再运用匹配后的数据进行效果评价。结果匹配后两组各766例,两组一般资料比较,差异无统计学意义(P<0.05)。与专科组比较,日间组住院日[1(1,1)d vs.4(3,4)d]、住院总费用[4649.75(4247.93,5333.15)元vs.7701.93(6864.23,8483.59)元]、西药费[285.71(210.83,355.01)元vs.655.73(522.98,809.69)元]、Ⅰ/甲切口愈合比例(0.13%vs.67.49%)和出院后30 d非计划入院比例更低(0.39%vs.1.44%),差异有统计学意义(P<0.05)。两组术后均未发生并发症。结论实施日间手术模式的腹腔镜下腹股沟斜疝疝囊高位结扎术可有效提升医疗资源利用效率,降低平均住院日,减轻患儿及家庭经济负担。

Objective To evaluate the implementation effect of high ligation of hernia sac in children with oblique inguinal hernia under day laparoscope based on propensity index matching method.Methods The data on the first page of medical records in 2789 children patients with oblique inguinal hernia in this hospital during the discharge time from January 1,2019 to December 31,2021 were collected.The children patients with the day surgery mode served as the day group(766 cases)and those with the general specialist hospitalization surgery mode served as the specialist group(2023 cases).The tendency score matching method was used to balance the confounding factors in the two group by a 1∶1 ratio,and then the matched data were used to conduct the effect evaluation.Results After matching,there were each 766 cases in the two groups.The general data had no statistical difference between the two groups(P>0.05).Compared with the specialist group,the average hospitalization days,total hospitalization costs,western medicine costs,proportions of classⅠ/A incision healing rate and unplanned admission rates within 30 d after discharge in the in the day group were lower[1(1,1)vs.4(3,4);4649.75(4247.93,5333.15)Yuan vs.7701.93(6864.23,8483.59)Yuan;285.71(210.83,355.01)Yuan vs.655.73(522.98,809.69)Yuan;0.13%vs.67.48%;0.39%vs.1.44%],and the differences were statistically significant(P<0.05).No complications occurred after operation in the two group(P<0.05).Conclusion The implementation of day surgery mode for high ligation of hernia sac in the children patients with oblique inguinal hernia under day laparoscope can effectively increase the utilization efficiency of medical resources,reduce the average hospital stay and decrease the economic burden of children and their families.