脊柱内镜在日间模式下治疗腰椎间盘突出症的卫生经济学效益分析  

Health and economic benefit analysis of spinal endoscopy in the treatment of lumbar disc herniation in day mode

作　　者：陶宇洪 武成志 崔成文 曹洪海[4] 黄鹏[4] TAO Yu-hong;WU Cheng-zhi;CUI Cheng-wen;CAO Hong-hai;HUANG Peng(Chinese PLA Medical School,Beijing,100853,China)

机构地区：[1]解放军医学院,北京100853 [2]克什克腾旗人民医院骨科,内蒙古025350 [3]解放军总医院第四医学中心康复医学科,北京100853 [4]解放军总医院第一医学中心骨科,北京100853

出　　处：《中国骨与关节杂志》2022年第9期664-667,共4页Chinese Journal of Bone and Joint

基　　金：解放军总医院院内创新项目(CX19001)。

摘　　要：目的探讨日间手术模式的可行性及其对经皮脊柱内镜治疗腰椎间盘突出症直接花费的影响。方法回顾性分析2017年1-6月,就诊于解放军总医院第一医学中心骨科以经皮脊柱内镜腰椎间盘摘除术治疗腰椎间盘突出症的患者139例,其中采用日间手术模式患者107例,住院手术模式患者32例。通过统计学方法分析日间手术和住院手术两种模式下患者住院总费用(包括手术相关费用、护理费、床位费和其它费用)、住院时间、手术时间、术中出血量及入院与出院时疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)等。结果日间手术组患者的住院时间、住院总费用、护理费、床位费和其它费用均显著低于住院手术组,差异有统计学意义(P<0.001),两组患者手术时间、术中出血量、入院和出院时VAS评分、ODI评分、并发症发生率差异无统计学意义(P>0.05),两组患者手术相关费用差异无统计学意义(P>0.05)。结论应用日间手术模式以经皮脊柱内镜腰椎间盘摘除术治疗腰椎间盘突出症可取得住院手术模式相同的治疗效果,并能显著缩短患者平均住院日、降低住院总费用,可见日间手术模式安全可行,能够作为常规住院手术外的治疗模式进一步推广。Objective To investigate the feasibility of the day surgery model and its impact on the direct cost of percutaneous endoscopic lumbar discectomy for lumbar disc herniation.Methods A retrospective analysis was performed on 139 patients with lumbar disc herniation.All were treated by percutaneous endoscopic lumbar discectomy in the Department of Orthopedics of the First Medical Center of Chinese PLA General Hospital from January 2017 to June 2017.Among them,107 patients were treated by day surgery mode and 32 patients were treated by inpatient surgery mode.Statistical methods were used to analyze the total hospitalization cost(including surgery-related expenses,nursing expenses,bed expenses and other expenses),hospitalization time,operative duration,intraoperative blood loss,VAS score and ODI score at admission and discharge under the two modes of day surgery and inpatient surgery.Results Hospitalization time,total hospitalization cost,nursing cost,bed cost and other costs of the day surgery group were significantly lower than those of the inpatient surgery group(P<0.001),and there were no significant differences in operative duration,intraoperative blood loss,VAS score and ODI score at admission and discharge,and complication rate between the two groups(P>0.05).There was no significant difference in surgery-related costs between the two groups(P>0.05).Conclusions Day surgery mode percutaneous endoscopic lumbar discectomy can achieve the same therapeutic effect as inpatient surgery mode,and it can significantly shorten the average inpatient time and reduce the gross cost of hospitalization.Day surgery mode is safe and feasible,which can be used as a regular hospital surgery treatment mode.

关 键 词：最小侵入性外科手术 椎间盘移位 腰椎 日间手术 经济学 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]