成人腹股沟疝日间手术患者住院费用影响因素分析

Analysis of factors influencing hospitalization costs for adult patients undergoing daytime surgery for inguinal hernia

目的探讨成人腹股沟疝日间手术患者住院费用的影响因素,为制定合理的医疗费用控制策略提供依据。方法根据纳入和排除标准,从首都医科大学附属北京朝阳医院的电子病历系统数据库中选取了2018年1月—2023年6月疝和腹壁外科收治的成人腹股沟疝日间手术患者为研究对象。收集患者的基本信息、疝相关信息、手术相关信息、费用相关信息等资料。采用分位数回归模型和分位数回归曲线图分析影响住院费用的因素,考察不同分位数下的影响因素。结果本研究共纳入成人腹股沟疝日间手术患者7985名。男性91.1%(7272/7985)较女性多。单因素分析的结果显示,年龄、住院次数、入院年份、其他诊断个数、手术方式和是否使用抗菌药物不同,住院费用差异有统计学意义(P<0.05)。分位数回归模型分析的结果显示,在年龄方面,患者年龄与住院费用在各个分位组呈负相关,年龄较大的患者在q70费用组的住院费用明显降低,年龄每增加1岁,医疗费用平均减少100.681元(P<0.001)。对于住院次数(住院次数>1的患者为既往因其他疾病入院治疗),相较于住院次数≥3次的患者,住院2次的患者在q10~q20、q50、q80~q90分位数的住院费用均明显上升(P<0.05),而住院1次的患者在各个分位数的费用显著增加(P<0.001)。随着入院年份的增加,各分位数的住院费用均呈显著上升趋势(P<0.05)。在其他诊断个数方面,比起其他诊断个数≥3个的患者,当存在0个其他诊断时,在q20分位数患者的费用略有下降(P<0.001),而在q60及q90分位数的费用明显上升(P<0.05);对于有1个其他诊断的患者,在q40~q60及q90分位数,住院费用也显著增加(P<0.05);对于有2个其他诊断的患者,在q40~q90分位数的费用明显增加(P<0.05)。手术方式上,腹腔镜手术在q10~q90分位数的住院费用均明显高于开放手术,且呈上升趋势(P<0.001)。最后,与未使用抗菌药物的患者相比,使用抗菌药物的患者住院费用显著增加(P<0.001)。结论住院费用高更常见于年轻患者、既往住院次数较少、住院年份较晚、其他诊断更多、采用腹腔镜手术技术以及使用抗菌药物的患者。未来研究需进一步拓展到其他疾病和手术类型,以期为医疗费用控制提供更全面的参考依据。

Objective To investigate the factors influencing hospitalization costs of adult patients undergoing day surgery for inguinal hernia,and to provide a basis for developing rational medical cost control strategies.Methods Based on inclusion and exclusion criteria,adult patients who underwent day surgery for inguinal hernia between January 2018 and June 2023 in the Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital,Capital Medical University,were selected from the electronic medical record system database.Patients'basic information,hernia-related information,surgery-related information,and cost-related information were collected.Quantile regression models and quantile regression curves were used to analyze the factors affecting hospitalization costs and to examine the factors at different quantiles.Results A total of 7,985 patients undergoing day surgery for inguinal hernia were included in this study.Male patients constituted 91.1%(7272/7985)of the sample,outnumbering female patients.Univariate analysis showed that age,number of hospitalizations,admission year,number of other diagnoses,surgical method,and the use of antimicrobial drugs were significantly related with different hospitalization costs(P<0.05).Quantile regression model analysis revealed that in terms of age,there was a negative correlation between patient age and hospitalization costs across various quantiles.For older patients in the q70 cost group,hospitalization costs significantly decreased,with an average reduction of 100.681 Yuan per additional year of age(P<0.001).Regarding the number of hospital stays(patients with hospitalizations>1 were hospitalized for other diseases in the past),compared to patients with≥3 hospitalizations,patients hospitalized twice showed a significant increase in costs at the q10 to q20,q50,and q80 to q90 quantiles(P<0.05),and patients hospitalized once exhibited a significant increase in costs across all quantiles(P<0.001).As admission years increased,there was a significant upward trend in hospitalization costs at all quantiles(P<0.05).In terms of the number of other diagnoses,compared to patients with≥3 other diagnoses,patients with no other diagnoses showed a slight decrease in costs at the q20 quantile(P<0.001),while costs significantly increased at the q60 and q90 quantiles(P<0.05);for patients with one other diagnosis,costs significantly increased at the q40-q60,and q90 quantiles(P<0.05);and for patients with two other diagnoses,costs significantly increased from the q40 to q90 quantiles(P<0.05).Regarding surgical methods,costs for laparoscopic surgery were significantly higher than that for open surgery across the q10 to q90 quantiles,with an upward trend(P<0.001).Finally,compared to patients who did not use antimicrobial drugs,those who did showed a significant increase in hospitalization costs(P<0.001).Conclusion Higher hospitalization costs were more common among patients who were younger,had fewer previous hospitalizations,were admitted in later years,had more other diagnoses,underwent laparoscopic surgery,and used antimicrobial drugs.Future research should further expand to other diseases and types of surgery to provide a more comprehensive reference for medical cost control.