宫颈癌手术患者住院费用的影响因素分析

Analysis on influencing factors of hospitalization expenses of patients with cervical cancer after operation

目的分析宫颈癌手术患者住院费用的主要影响因素,为进一步进行标准临床路径的管理、管控医疗成本、降低患者医疗费用提供参考。方法调取山东省某市三甲医院2020-2021年收治的450例宫颈癌手术患者的病例资料,收集年龄、住院天数、医疗付费方式、主要诊断、手术方式、是否纳入临床路径、住院总费用等资料。采用非参数检验、多元线性回归法对影响患者住院费用的因素进行分析。结果450例宫颈癌手术患者的住院费用中位数为24880.28元,其中治疗费用(占29.75%)、耗材费用(占28.28%)以及手术费用(占15.61%)占比较高。不同年龄(P=0.007)、住院天数(P<0.001)、住院次数(P=0.007)、医疗付费方式(P=0.039)、是否使用腔镜(P<0.001)、是否纳入临床路径(P<0.001)宫颈癌手术住院患者的住院费用差异均有统计学意义。纳入临床路径的宫颈癌患者住院天数缩短,住院总费用、手术费用、耗材费用、西药费用、综合服务类费用、抗菌药物的费用均下降(P<0.001)。住院天数(t=11.065)、是否纳入临床路径(t=-6.764)、是否使用腔镜(t=-4.923)是宫颈癌手术患者住院费用的影响因素(P<0.001)。结论住院天数、是否纳入临床路径及是否使用腹腔镜是宫颈癌手术患者住院费用的影响因素。

Objective To analyze the main influencing factors of hospitalization costs for cervical cancer surgery patients,so as to provide reference for further management of standard clinical pathways,control of medical costs and reduction of patients'medical costs.Methods A total of 450 cases of cervical cancer surgery patients from a tertiary hospital in Shandong province from 2020 to 2021 were collected,including age,length of hospital stay,medical payment method,main diagnosis,surgical method,inclusion in clinical pathway,and total hospitalization cost.Non-parametric tests and multiple linear regression were used to analyse the factors affecting patients'hospitalisation costs.Results The median hospitalization cost of 450 patients with cervical cancer was 24880.28 yuan,among which the treatment cost(29.75%),the consumable material cost(28.28%)and the operation cost(15.61%)were higher.There were significant differences in hospitalization cost among different age(P=0.007),days in hospital(P<0.001),times in hospital(P=0.007),mode of medical payment(P=0.039),whether to use laparoscopy(P<0.001)and whether to include clinical pathway(P<0.001).The days of hospitalisation reduced for cervical cancer patients included in the clinical pathway,the total cost of hospitalization,operation cost,consumables cost,western medicine cost,general service cost and antibacterial drug cost were all decreased(P<0.001).The length of hospital stay(t=11.065),whether to include clinical pathway(t=-6.764)and whether to use laparoscopy(t=-4.923)were the influencing factors of the cost of hospitalization for patients undergoing cervical cancer surgery(P<0.001).Conclusion The length of hospital stay,clinical pathway and laparoscopy are the influencing factors of the cost of cervical cancer surgery.