胸外科达芬奇机器人术后医院感染经济损失——一项基于倾向性评分匹配的回顾性研究  

Economic losses due to healthcare-associated infection after Da Vinci robotic thoracic surgery:a retrospective study based on propensity score matching

作　　者：张丽伟[1] 狄佳[1] 陶源[2] 冯诚怿 朱丽丽 金丹 江淑芳[1] ZHANG Liwei;DI Jia;TAO Yuan;FENG Chengyi;ZHU Lili;JIN Dan;JIANG Shufang(Department of Infection Management,The First People’Hospital of Changzhou,Changzhou 213003,China;Department of Quality Control,The First People’Hospital of Changzhou,Changzhou 213003,China)

机构地区：[1]江苏省常州市第一人民医院感染管理处,江苏常州213003 [2]江苏省常州市第一人民医院质控处,江苏常州213003

出　　处：《中国感染控制杂志》2025年第4期518-525,共8页Chinese Journal of Infection Control

基　　金：国家自然科学基金青年项目(81502002);常州市卫健委青年人才项目(QN202019、QN202355);江苏省现代医院管理研究中心医院管理研究立项课题(JSY-3-2019-098)。

摘　　要：目的了解胸外科达芬奇机器人术后患者发生医院感染所造成的经济学损失,为预防与控制机器人术后医院感染提供依据。方法采用回顾性研究,选取某院2019年4月—2023年4月于胸外科进行达芬奇机器人手术患者,依据术后是否发生医院感染,将其分为医院感染组和非医院感染组。通过1∶1倾向性评分匹配(PSM),两组各纳入31例,比较两组患者的经济损失。结果共纳入胸外科达芬奇机器人手术患者921例,发生医院感染51例(医院感染组),未发生医院感染870例(非医院感染组)。通过1∶1 PSM后,两组各纳入31例。PSM前两组患者性别、年龄、疾病合并情况、美国麻醉医师(ASA)分级4个协变量比较,差异有统计学意义(均P<0.05);PSM后以上协变量在两组间分布都达到均衡(均P>0.05)。PSM后医院感染组住院期间总费用中位数为88711.72元,非医院感染组为78509.46元,达芬奇机器人手术医院感染造成的直接经济损失为10202.26元,主要增加的费用为药费、护理费、实验室诊断费等,西药费差值最高达8839.12元,其中以西药费中的抗菌药物费用差值占比最高,达73.55%。医院感染组与非医院感染组患者日均住院费用差值为502.38元;医院感染组患者住院日数为(21.59±10.62)d,非医院感染组患者住院日数为(13.92±9.21)d,差异均具有统计学意义(均P<0.05)。结论胸外科达芬奇机器人术后患者发生医院感染造成了一定的直接经济损失,护理费、实验室诊断费、西药费(主要为抗菌药物费用)明显上升,且延长患者住院日数。Objective To understand the economic losses due to healthcare-associated infection(HAI)in patients after Da Vinci robotic thoracic surgery,and provide basis for preventing and controlling HAI after robotic surgery.Methods Patients who underwent Da Vinci robotic surgery from April 2019 to April 2023 were retrospective stu-died.Patients were divided into HAI group and non-HAI group based on the occurrence of postoperative infection.Through 1∶1 propensity score matching(PSM),31 cases were included in each group,economic losses of two groups of patients were compared.Results A total of 921 patients who underwent Da Vinci robotic thoracic surgery were included in the study,51 cases with HAI(HAI group)and 870 without HAI(non-HAI group).After 1∶1 PSM,31 cases were included in each group.Four covariates were compared between two groups of patients before PSM,namely gender,age,comorbidities,and the American Society of Anesthesiologists(ASA)grading,all with statistically significant differences(all P<0.05).After PSM,distribution of the above covariates reached equilib-rium between the two groups(both P>0.05).The median total expense for HAI group before PSM during hospitalization was 88711.72 Yuan,while 78509.46 Yuan for the non-HAI group.The direct economic losses caused by HAI after Da Vinci robot surgery was 10202.26 Yuan,mainly increased by expense of medicine,nursing,laboratory diagnosis,etc.Difference in western medicine expense was the highest(8839.12 Yuan),out of which expense of antimicrobial agents accounted for the highest proportion(73.55%).Difference in daily hospitalization expense between HAI-group and non-HAI group was 502.38 Yuan.Length of hospital stay of patients in HAI group and non-HAI group were(21.59±10.62)and(13.92±9.21)days,respectively,with statistical differences(all P<0.05).Conclusion The occurrence of HAI in patients undergoing Da Vinci robotic thoracic surgery leads to direct economic losses,with obvious increases in expenses of nursing,laboratory diagnosis,western medicine(mainly antimi

关 键 词：手术后感染 医院感染 经济损失 达芬奇机器人 胸外科 倾向性评分匹配 

分 类 号：R184.32[医药卫生—流行病学]