Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Met...Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Methods:A retrospective cohort study was conducted among 81 patients with single simple renal cyst who had undergone retroperitoneal laparoscopic cyst decortication from January 2017 to December 2019 in Wuxi Xishan People's Hospital.All patients were divided into three groups according to BMI:normal group(BMI<25 kg/m^(2),n=44),overweight group(BMI=25-30 kg/m^(2),n=21),and obese group(BMI>30 kg/m^(2),n=16).Multiple linear regression was conducted to investigate the correlation.Results:The three groups were comparable in terms of age,gender,maximum diameter of cyst,and cyst location.In the aspect of operation time,only the patients in obese group had longer duration when compared with those in the normal group(59.1±15.7 min vs.45.2±12.8 min,p=0.001).And the patients in the obese group had significantly longer hospital stay compared with those in the normal group(6.2±1.9 d vs.5.2±0.5 d,p=0.002)and overweight group(6.2±1.9 d vs.5.0±1.0d,p=0.001).In the analysis of multiple linear regression,it was found that operation time is significantly affected by BMI and location 2,with coefficients of 1.299 and -8.646 respectively.The influence of BMI was greater than location 2(0.335 vs.-0.289).For hospital stay,only BMI had an effect on it,with a coefficient of 0.110.Conclusion:BMI was a major factor that associated with longer operation time and hospital stay in patients with retroperitoneal laparoscopic renal cyst decortication.展开更多
Following the recommendations of a report submitted by the Central Social Insurance Medical Council concerning the 2002 revision of the Medical Service Fee Schedule, a new inclu-sive payment system, which is based on ...Following the recommendations of a report submitted by the Central Social Insurance Medical Council concerning the 2002 revision of the Medical Service Fee Schedule, a new inclu-sive payment system, which is based on the Diagnosis Procedure Combination (DPC) sys-tem, was introduced in 82 special functioning hospitals in Japan, effective beginning in April 2003. Since April 2004, the system has been gradually extended to general hospitals that satisfy certain prerequisites. In this paper, the new inclusive payment system is analyzed. Data pertaining to 1,225 patients, who were hospital-ized for cataract diseases and underwent lens operations from July 2004 to September 2005, are used. The lengths of hospital stay and medical payments among hospitals are com-pared. Even after eliminating the influence of patient characteristics, there are large differ-ences among hospitals in average lengths of hospital stay and DPC-based inclusive pay-ments. The highest average inclusive payment is 3.5 times as high as the lowest payment. On the other hand, there are relatively small differ-ences in non-inclusive payments based on the conventional fee-for-service system—the larg-est deviation from the average of all hospitals is approximately 10%. Thus, although payments based on the DPC account for only one-third of the total medical payments for this disease, the major differences in medical payments among hospitals are caused by differences in their DPC-based inclusive payments. The results of the study strongly suggest that revisions of the payment system in Japan are necessary for the efficient use of medical resources in the future.展开更多
Objective: To measure the hospital operation efficiency, study the correlation between average length of stay and hospital operation efficiency, analyze the importance of shortening average length of stay to the impro...Objective: To measure the hospital operation efficiency, study the correlation between average length of stay and hospital operation efficiency, analyze the importance of shortening average length of stay to the improvement of the hospital operation efficiency and put forward relevant policy suggestion. Methods: Based on China provincial panel data from 2003 to 2012, the hospital operation efficiencies are calculated using Super Efficiency Data Envelopment Analysis model, and the correlation between average length of stay and hospital operation efficiency is tested using Spearman rank correlation coefficient test. Results: From 2003 to 2012, the average of national hospital operation efficiency was increasing slowly and the hospital operations were inefficient in most of the areas. The national hospital operation efficiency is negatively correlated to the average length of stay. Conclusion: Measures should be taken to set average length of stay in a scientific and reasonable way, improve social and economic benefits based on the improvement of efficiency.展开更多
BACKGROUND Timing of invasive intervention such as operative pancreatic debridement(OPD)in patients with acute necrotizing pancreatitis(ANP)is linked to the degree of encapsulation in necrotic collections and controll...BACKGROUND Timing of invasive intervention such as operative pancreatic debridement(OPD)in patients with acute necrotizing pancreatitis(ANP)is linked to the degree of encapsulation in necrotic collections and controlled inflammation.Additional markers of these processes might assist decision-making on the timing of surgical intervention.In our opinion,it is logical to search for such markers among routine laboratory parameters traditionally used in ANP patients,considering simplicity and cost-efficacy of routine laboratory methodologies.AIM To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use in the timing of surgery.METHODS A retrospective analysis of routine laboratory parameters in 53 ANP patients undergoing OPD between 2017 and 2020 was performed.Dynamic changes of routine hematological and biochemical indices were examined in the preoperative period.Patients were divided into survivors and non-survivors.Survivors were divided into subgroups with short and long post-surgery length of stay(LOS)in hospital.Correlation analysis was used to evaluate association of laboratory variables with LOS.Logistic regression was used to assess risk factors for patient mortality.RESULTS Seven patients(15%)with severe acute pancreatitis(SAP)and 46 patients(85%)with moderately SAP(MSAP)were included in the study.Median age of participants was 43.2 years;33(62.3%)were male.Pancreatitis etiology included biliary(15%),alcohol(80%),and idiopathic/other(5%).Median time from diagnosis to OPD was≥4 wk.Median postoperative LOS was at the average of 53 d.Mortality was 19%.Progressive increase of platelet count in preoperative period was associated with shortened LOS.Increased aspartate aminotransferase and direct bilirubin(DB)levels the day before the OPD along with weak progressive decrease of DB in preoperative period were reliable predictors for ANP patient mortality.CONCLUSION Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.展开更多
目的对比腹腔镜与开腹阑尾切除术对阑尾炎患者的手术效果及对视觉模拟评分法(VAS)评分的影响。方法回顾性分析2021年10月至2022年10月黄石市妇幼保健院收治的104例阑尾炎患者的临床资料,依据手术方式的不同分为常规组(采用开腹阑尾切除...目的对比腹腔镜与开腹阑尾切除术对阑尾炎患者的手术效果及对视觉模拟评分法(VAS)评分的影响。方法回顾性分析2021年10月至2022年10月黄石市妇幼保健院收治的104例阑尾炎患者的临床资料,依据手术方式的不同分为常规组(采用开腹阑尾切除术治疗,52例)和观察组(采用腹腔镜阑尾切除术治疗,52例)。观察组男30例,女22例,年龄(39.63±7.25)岁,发病至手术时间(20.36±5.85)h;常规组男31例,女21例,年龄(39.89±8.14)岁,发病至手术时间(21.58±6.74)h。对比两组患者手术相关指标、疼痛状况、外周血单核细胞中核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、分泌型卷曲相关蛋白-5(SFRP-5)、术后并发症发生情况。采用χ^(2)检验、t检验。结果观察组手术时间、下床时间、排气时间、住院时间均短于常规组(均P<0.05)。与术前相比,两组患者术后12 h VAS评分均降低(均P<0.05),观察组术后12 h VAS评分低于常规组[(2.59±0.28)分比(4.69±0.33)分](P<0.05)。两组患者术前NLRP3 mRNA、SFRP-5比较,差异均无统计学意义(均P>0.05);与术前相比,两组患者术后3 d NLRP3 mRNA、SFRP-5均降低(均P<0.05),观察组术后3 d NLRP3 mRNA、SFRP-5均低于常规组(均P<0.05)。观察组并发症总发生率低于常规组[5.77%(3/52)比21.15%(11/52)](P<0.05)。结论阑尾炎采用腹腔镜阑尾切除手术治疗效果较好,可以缩短患者的手术时间、下床时间、排气时间、住院时间,降低VAS评分,减轻患者的炎性反应,降低并发症总发生率,值得在临床上推广与应用。展开更多
文摘Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Methods:A retrospective cohort study was conducted among 81 patients with single simple renal cyst who had undergone retroperitoneal laparoscopic cyst decortication from January 2017 to December 2019 in Wuxi Xishan People's Hospital.All patients were divided into three groups according to BMI:normal group(BMI<25 kg/m^(2),n=44),overweight group(BMI=25-30 kg/m^(2),n=21),and obese group(BMI>30 kg/m^(2),n=16).Multiple linear regression was conducted to investigate the correlation.Results:The three groups were comparable in terms of age,gender,maximum diameter of cyst,and cyst location.In the aspect of operation time,only the patients in obese group had longer duration when compared with those in the normal group(59.1±15.7 min vs.45.2±12.8 min,p=0.001).And the patients in the obese group had significantly longer hospital stay compared with those in the normal group(6.2±1.9 d vs.5.2±0.5 d,p=0.002)and overweight group(6.2±1.9 d vs.5.0±1.0d,p=0.001).In the analysis of multiple linear regression,it was found that operation time is significantly affected by BMI and location 2,with coefficients of 1.299 and -8.646 respectively.The influence of BMI was greater than location 2(0.335 vs.-0.289).For hospital stay,only BMI had an effect on it,with a coefficient of 0.110.Conclusion:BMI was a major factor that associated with longer operation time and hospital stay in patients with retroperitoneal laparoscopic renal cyst decortication.
文摘Following the recommendations of a report submitted by the Central Social Insurance Medical Council concerning the 2002 revision of the Medical Service Fee Schedule, a new inclu-sive payment system, which is based on the Diagnosis Procedure Combination (DPC) sys-tem, was introduced in 82 special functioning hospitals in Japan, effective beginning in April 2003. Since April 2004, the system has been gradually extended to general hospitals that satisfy certain prerequisites. In this paper, the new inclusive payment system is analyzed. Data pertaining to 1,225 patients, who were hospital-ized for cataract diseases and underwent lens operations from July 2004 to September 2005, are used. The lengths of hospital stay and medical payments among hospitals are com-pared. Even after eliminating the influence of patient characteristics, there are large differ-ences among hospitals in average lengths of hospital stay and DPC-based inclusive pay-ments. The highest average inclusive payment is 3.5 times as high as the lowest payment. On the other hand, there are relatively small differ-ences in non-inclusive payments based on the conventional fee-for-service system—the larg-est deviation from the average of all hospitals is approximately 10%. Thus, although payments based on the DPC account for only one-third of the total medical payments for this disease, the major differences in medical payments among hospitals are caused by differences in their DPC-based inclusive payments. The results of the study strongly suggest that revisions of the payment system in Japan are necessary for the efficient use of medical resources in the future.
文摘Objective: To measure the hospital operation efficiency, study the correlation between average length of stay and hospital operation efficiency, analyze the importance of shortening average length of stay to the improvement of the hospital operation efficiency and put forward relevant policy suggestion. Methods: Based on China provincial panel data from 2003 to 2012, the hospital operation efficiencies are calculated using Super Efficiency Data Envelopment Analysis model, and the correlation between average length of stay and hospital operation efficiency is tested using Spearman rank correlation coefficient test. Results: From 2003 to 2012, the average of national hospital operation efficiency was increasing slowly and the hospital operations were inefficient in most of the areas. The national hospital operation efficiency is negatively correlated to the average length of stay. Conclusion: Measures should be taken to set average length of stay in a scientific and reasonable way, improve social and economic benefits based on the improvement of efficiency.
基金中国卫生经济学会第十九批招标课题“公立医院管理会计现状和体系建设研究”(CHEA1819040401)国际糖尿病联盟青岛糖尿病足病防治项目“The impact of initiation of aneducational and preventive foot care center for subjects with diabetes in Qingdao,China”(rn13-016)。
文摘BACKGROUND Timing of invasive intervention such as operative pancreatic debridement(OPD)in patients with acute necrotizing pancreatitis(ANP)is linked to the degree of encapsulation in necrotic collections and controlled inflammation.Additional markers of these processes might assist decision-making on the timing of surgical intervention.In our opinion,it is logical to search for such markers among routine laboratory parameters traditionally used in ANP patients,considering simplicity and cost-efficacy of routine laboratory methodologies.AIM To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use in the timing of surgery.METHODS A retrospective analysis of routine laboratory parameters in 53 ANP patients undergoing OPD between 2017 and 2020 was performed.Dynamic changes of routine hematological and biochemical indices were examined in the preoperative period.Patients were divided into survivors and non-survivors.Survivors were divided into subgroups with short and long post-surgery length of stay(LOS)in hospital.Correlation analysis was used to evaluate association of laboratory variables with LOS.Logistic regression was used to assess risk factors for patient mortality.RESULTS Seven patients(15%)with severe acute pancreatitis(SAP)and 46 patients(85%)with moderately SAP(MSAP)were included in the study.Median age of participants was 43.2 years;33(62.3%)were male.Pancreatitis etiology included biliary(15%),alcohol(80%),and idiopathic/other(5%).Median time from diagnosis to OPD was≥4 wk.Median postoperative LOS was at the average of 53 d.Mortality was 19%.Progressive increase of platelet count in preoperative period was associated with shortened LOS.Increased aspartate aminotransferase and direct bilirubin(DB)levels the day before the OPD along with weak progressive decrease of DB in preoperative period were reliable predictors for ANP patient mortality.CONCLUSION Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.
文摘目的对比腹腔镜与开腹阑尾切除术对阑尾炎患者的手术效果及对视觉模拟评分法(VAS)评分的影响。方法回顾性分析2021年10月至2022年10月黄石市妇幼保健院收治的104例阑尾炎患者的临床资料,依据手术方式的不同分为常规组(采用开腹阑尾切除术治疗,52例)和观察组(采用腹腔镜阑尾切除术治疗,52例)。观察组男30例,女22例,年龄(39.63±7.25)岁,发病至手术时间(20.36±5.85)h;常规组男31例,女21例,年龄(39.89±8.14)岁,发病至手术时间(21.58±6.74)h。对比两组患者手术相关指标、疼痛状况、外周血单核细胞中核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、分泌型卷曲相关蛋白-5(SFRP-5)、术后并发症发生情况。采用χ^(2)检验、t检验。结果观察组手术时间、下床时间、排气时间、住院时间均短于常规组(均P<0.05)。与术前相比,两组患者术后12 h VAS评分均降低(均P<0.05),观察组术后12 h VAS评分低于常规组[(2.59±0.28)分比(4.69±0.33)分](P<0.05)。两组患者术前NLRP3 mRNA、SFRP-5比较,差异均无统计学意义(均P>0.05);与术前相比,两组患者术后3 d NLRP3 mRNA、SFRP-5均降低(均P<0.05),观察组术后3 d NLRP3 mRNA、SFRP-5均低于常规组(均P<0.05)。观察组并发症总发生率低于常规组[5.77%(3/52)比21.15%(11/52)](P<0.05)。结论阑尾炎采用腹腔镜阑尾切除手术治疗效果较好,可以缩短患者的手术时间、下床时间、排气时间、住院时间,降低VAS评分,减轻患者的炎性反应,降低并发症总发生率,值得在临床上推广与应用。
