DRG付费背景下不同肺部恶性肿瘤手术的真实世界数据对比研究  

A comparative study with real-world data of different surgery for lung malignancies in the context of DRG payment

作　　者：伍渊麟 刘耀 甘岚澜 向贵圆 李晨 陈世耕 鲜秋婉 WU Yuanlin;LIU Yao;GAN Lanlan;XIANG Guiyuan;LI Chen;CHEN Shigeng;XIAN Qiuwan(Department of Pharmacy,Daping Hospital,Army Military Medical University,Chongqing 400042,China;Medical Insurance Office of Medical Research Department,Daping Hospital,Army Military Medical University,Chongqing 400042,China;Medical Office of Medical Research Department,Daping Hospital,Army Military Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院药剂科,重庆400042 [2]陆军军医大学大坪医院医研部医保办,重庆400042 [3]陆军军医大学大坪医院医研部医疗办,重庆400042

出　　处：《重庆医学》2024年第11期1645-1649,共5页Chongqing medicine

基　　金：重庆市临床药学重点专科建设项目(渝卫办发[2020]68号);重庆市技术创新与应用发展专项重点项目(CST2021jscx-gksb-N0013);陆军军医大学科技创新能力提升专项项目(2019XLC3042)。

摘　　要：目的 比较机器人胸部手术和腔镜胸部手术治疗肺部恶性肿瘤的安全性、有效性及经济性,为医院及医疗保险相关部门肺部恶性肿瘤不同手术方式的管理提供依据。方法 收集该院出院时间为2022年1月1日至12月31日行胸部大手术的肺部恶性肿瘤患者的病案首页及信息系统数据,根据手术方式将患者分为机器人胸部手术组和腔镜胸部手术组,通过倾向得分匹配(PSM)获得两组基线资料无明显差异的数据(各117例),对比两组安全性、有效性及经济性指标。结果 安全性方面,机器人胸部手术组术后切口感染率明显低于腔镜胸部手术组(P<0.05),两组术中出血量和术后并发症发生率无明显差异(P>0.05);有效性方面,机器人胸部手术组例均手术时间较腔镜胸部手术组明显缩短(P<0.05),两组均无术中转开胸患者,两组例均住院时间和术后住院时间均无明显差异(P>0.05);经济性方面,机器人胸部手术组例均住院费用和例均日住院费用均明显高于腔镜胸部手术组(P<0.05),且两种术式的费用结构存在差异,机器人胸部手术组医疗费用、管理费用和耗材费用均明显高于腔镜胸部手术组(P<0.05),医技费用明显低于腔镜胸部手术组(P<0.05)。结论 医生要综合考虑临床疗效和患者费用负担选择使用机器人胸部手术或腔镜胸部手术进行治疗,并加强对临床机器人胸部手术使用的监测和评价。Objective To compare the safety,effectiveness and affordability of robotic-assisted thoracic surgery and video-assisted thoracic surgery in the treatment of malignant pulmonary tumors,and provide references for the management of selection of different surgical strategies for malignant pulmonary tumors in hospitals and medical insurance departments.Methods The medical records homepages and information system data of patients with malignant pulmonary tumors who underwent major thoracic surgery in this hospital and discharged from January 1 to December 31,2022 were obtained.The patients were divided into the robotic-assisted thoracic surgery group and video-assisted thoracic surgery group according to the surgical methodologies.After performing propensity score matching(PSM),no statistically significant difference was observed in baseline data between the two groups(117 cases in each group).Then the indicators of safety,effectiveness and affordability were compared between the two groups.Results Concerning the safety,the postoperative incision infection rate in the robotic-assisted thoracic surgery group was significantly lower than that in the video-assisted thoracic surgery group(P<0.05),and the amount of intraoperative blood loss and postoperative complication rate were not significantly different between the two groups(P>0.05).Regarding the effectiveness,the average surgical duration in the robotic-assisted thoracic surgery group was appreciably shorter than that in the video-assisted thoracic surgery group(P<0.05),no patient in the two groups was converted to open thoracotomy,and there was no statistically significant difference in the average length of hospital stay and postoperative hospital stay between the two groups(P>0.05).With regard to the affordability,the average inpatient expenditure per case and average daily inpatient expenditure per case in the robotic-assisted thoracic surgery group were significantly higher than those in the video-assisted thoracic surgery group(P<0.05),and there were disparitie

关 键 词：肺肿瘤 疾病诊断相关分组 机器人手术 胸外科手术 胸腔镜辅助 真实世界研究 

分 类 号：R734.2[医药卫生—肿瘤]