日间手术和住院手术在腹股沟疝无张力修补术应用中的卫生经济学评价  

Cost-Effectiveness Analysis of Day Surgery Versus Inpatient Surgery for Tension-Free Herniorrhaphy

作　　者：龚艳萍[1] 雷文章[1] 宋应寒[1] 班立杰[1] 

机构地区：[1]四川大学华西医院普外科,四川成都610041

出　　处：《中国普外基础与临床杂志》2015年第6期688-691,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的比较日间手术和住院手术两种方式在腹股沟疝无张力修补术中的疗效和医疗费用差异。方法前瞻性收集四川大学华西医院2010年1月到2010年9月期间收治的100例单侧腹股沟疝患者,随机分成2组:住院手术组50例和日间手术组50例,比较2组患者疗效和医疗费用的差异。结果 2组患者的手术时间、术中出血量、尿潴留发生率、阴囊积液水肿发生率、切口异物感发生率、总并发症发生率、术后下床活动时间和术后恢复上班时间比较差异均无统计学意义(P>0.05),但日间手术组的住院时间短于住院手术组(P<0.05)。日间手术组的住院总费用低于住院手术组(P<0.05),其中2组患者的术前总费用和术中总费用比较差异均无统计学意义(P>0.05),但日间手术组患者的术后总费用低于住院手术组(P<0.05)。在术中费用方面,2组患者的术中监护费、麻醉及材料费和术中药品费比较差异均无统计学意义(P>0.05);在术后费用方面,日间手术组的术后药品费、护理费、床位费及陪护费均低于住院手术组(P<0.05)。结论在对腹股沟疝行无张力修补术时,开展日间手术和住院手术的效果相似,但日间手术的总费用更低,周转率快,提高了医疗资源的利用率,减轻了患者的经济负担,也减轻了国家的医疗负担。Objective To explore the surgical effect and cost-effectiveness of day surgery versus inpatient surgery for tension-free herniorrhaphy. Methods A total of 100 cases of unilateral inguinal hernia who treated in West China Hospital of Sichuan University from jan. 2010 to Sep. 2010 were collected prospectively, and were randomly divided into 2 groups： day surgery group （50 cases） and inpatient surgery group （50 cases）. Comparison of the surgical effect and cost- effectiveness of day surgery versus inpatient surgery was performed. Results There was no significant difference in the operation time, blood loss during the operation, incidence of urinary retention, scrotal edema fluid, incision foreign body sensation, and total complications, the time of get out of bed after surgery, and the time of returning to work after surgery （P〉0.05）, but the hospital stay of day surgery group was shorter than that of inpatient surgery group （P〈0.05）. The total cost of day surgery group was lower than that of inpatient surgery group （P〈0.05）. There was no significant difference in the preoperation cost and introperative cost （P〉0.05）, but the postoperative cost of day surgery group was lower than that of inpatient surgery group （P〈0.05）. In the preoperation cost, there was no significant difference in the intraoperative monitoring fee, anesthesia and surgery materials fee, and drug charges （P〉0.05）, but in the postoperative cost, the drug charges, nursing care fee, bed fee, and escort fee of day surgery group were all lower than that of inpatient surgery group （P〈0.05）. Conclusions The effect of day surgery for tension-free herniorrhaphy is similar with inpatient surgery. But compared with inpatient surgery, the total cost of day surgery is lower, turn-over rate is higher, so it improves utilization of medical resources, reduces economic burden, and also reduces the medical burden of the country.

关 键 词：腹股沟疝无张力修补术 日间手术 住院手术 经济学评价 随机对照试验 

分 类 号：R656.21[医药卫生—外科学]