外科理论与实践

外科理论与实践 ›› 2022, Vol. 27 ›› Issue (04): 334-339.doi: 10.16139/j.1007-9610.2022.04.012

• 论著 • 上一篇    下一篇

基于专科化发展的胆囊切除术经济学成本分析

沈盛, 高志慧, 辛艳磊, 郑博豪, 刘厚宝, 锁涛()   

  1. 复旦大学附属中山医院普外科 复旦大学胆道疾病研究所 复旦大学附属中山医院胆道疾病诊疗中心,上海 200032
  • 收稿日期:2021-08-09 出版日期:2022-07-25 发布日期:2022-09-20
  • 通讯作者: 锁涛 E-mail:suo.tao@zs-hospital.sh.cn

Economic cost analysis of cholecystectomy based on development of specialization

SHEN Sheng, GAO Zhihui, XIN Yanlei, ZHENG Bohao, LIU Houbao, SUO Tao()   

  1. Department of General Surgery, Biliary Disease Institute, Medical Center of Biliary Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Received:2021-08-09 Online:2022-07-25 Published:2022-09-20
  • Contact: SUO Tao E-mail:suo.tao@zs-hospital.sh.cn

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摘要：

目的：从经济学成本分析专科与非专科医师行胆囊切除术治疗胆囊良性疾病的差异,探讨专科化发展对病人的影响。方法：回顾性分析2009—2018年在复旦大学附属中山医院行胆囊切除术胆囊良性疾病病人的一般信息、住院费用、术后住院时间。结果：经过字条检索及人工复核方式,共纳入11 635例,其中专科组4 350例,非专科组7 285例。两组腹腔镜手术比例差异无统计学意义(P=0.198)。2009—2018年期间,专科组与非专科组总费用相比增加,(15 721.60±9 888.82)元比(12 529.88±9 382.23)元;手术费增加,(5 110.43±1 416.40)元比(4 601.24±1 601.65)元;耗材费增加,(4 458.73±2 967.35)元比(4 080.49±2 377.83)元;药费、自费药费和护理费均增加,分别为(1 808.32±2 771.20)元比(1 562.51±3 648.92)元;(806.63±1 285.11)元比(637.14±1 071.00)元;(165.24±296.55)元比(129.24±398.01)元(P均<0.001)。专科组术后住院时间也明显长于非专科组,(2.51±2.39) d比(2.50±2.87) d,P<0.001。以2015年专科正式成立前后来对比,专科组腹腔镜手术占比明显升高,专科组总费用及手术费用仍高于非专科组,但药费、护理费已低于非专科组,术后住院时间也短于非专科组(P均<0.05)。结论：与非专科相比,专科医师行胆囊切除术治疗胆囊良性疾病时,总费用高,可能与复杂病例多有关。近期的药费及护理费降低、住院时间缩短,提示恢复较快,用药较少。

关键词: 胆囊切除术, 经济学成本, 专科化

Abstract:

Object To analyze the difference of economics cost between biliary surgeons and general surgeons in performing cholecystectomy for gallbladder benign diseases and the influence of specialization of surgery on patients. Methods The general information, hospitalization expenses and postoperative hospital stay of the patients with gallbladder benign diseases undergoing cholecystectomy from 2009 to 2018 in Zhongshan Hospital were analyzed retrospectively. Results There were 11 635 cases included in this study through the searching notes and manual review dividing 4 350 cases in biliary surgeon group and 7 285 cases in general surgeon group. There was no significant difference in ratio of laparosco-pic surgery between two groups(P=0.198). Total cost in biliary surgeon group was significantly higher than that in general surgeon group during 2009—2018, (15 721.60±9 888.82) yuan vs.(12 529.88±9 382.23) yuan. The increase in operative cost, (5 110.43±1 416.40) yuan vs. (4 601.24±1 601.65) yuan, material cost, (4 458.73±2 967.35 ) yuan vs. (4 080.49±2 377.83) yuan, drug cost, (1 808.32±2 771.20 ) yuan vs. (1 562.51±3 648.92) yuan, self-paying drug cost, (806.63±1 285.11) yuan vs. (637.14±1 071.00) yuan, and nursing cost, (165.24±296.55 ) yuan vs. (129.24±398.01) yuan, P<0.001 were higher significantly in biliary surgeon group than those in general surgeon group. Postoperative hospital stay was longer in biliary surgeon group than that in general surgeon group, (2.51±2.39) d vs. (2.50±2.87) d, P<0.001. After specialized grouping in 2015, the ratio of laparoscopic surgery in biliary surgeon group increased significantly. Total fee and operative cost in biliary surgeon group were higher than those in general surgeon group. However, both drug and nursing cost were lower in biliary surgeon group than those in general surgeon group, and postoperative hospital stay was shorter than that in general surgeon group (All P<0.05). Conclusions Compared with general surgeon group, total cost of cholecystectomy is higher in biliary surgeon group which might be due to the patients with complex disease. Drug and nursing cost are lower, and length of stay is shorter in recent years suggesting a faster recovery.

Key words: Cholecystectomy, Economic cost, Specialization

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