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目的对日间手术模式进行卫生经济学评价,为外科手术模式的优选和决策提供参照依据。方法选取2015年1月1日—12月31日在中南大学湘雅医院治疗的单侧输尿管软镜下钬激光碎石取石术患者,其中日间手术患者59例(日间组),泌尿结石亚专科住院手术患者65例(专科组)。比较两种手术模式下的平均占用床位时间、成本、治疗效果、满意度的差异。结果日间组与专科组平均占用床位时间分别为(1.03±0.18)、(6.35±0.74)d,差异有统计学意义(P<0.05)。两组均随访1个月,日间组术后并发症有4例(6.8%),专科组术后并发症有4例(6.2%),两组术后并发症发生率差异无统计学意义(P>0.05)。日间组与专科组患者满意度分别为(96.48±0.23)分和(96.53±0.18)分,差异无统计学意义(P>0.05)。日间组与专科组直接医疗成本分别为(17 738.28±1 027.85)、(21 307.67±554.41)元,直接非医疗成本分别为(103.39±18.25)、(630.76±78.90)元,间接成本分别为(266.93±47.12)、(1 640.44±190.55)元,总成本分别为(18 128.10±1 037.76)、(23 558.29±619.20)元,组间差异均有统计学意义(P<0.05)。日间组与专科组治疗效果指数分别为0.96和1.05,成本-效果比分别为18 883.44和22 436.47;进行敏感性分析,调整后的成本-效果比日间组为16 629.64,仍低于专科组的20 534.91。结论日间手术的成本-效果优于专科住院手术模式,患者满意度与专科住院模式无差异,可推荐符合日间手术指征的患者采用该模式。
Objective To evaluate the health economics of daytime operation mode and provide reference for the selection and decision-making of surgical operation mode. Methods From January 1, 2015 to December 31, 2015, patients undergoing unilateral ureteroscopic ureteroscopic holmium laser lithotripsy at Xiangya Hospital of Central South University were enrolled. Among them, 59 patients in daytime surgery (daytime group), urolithiasis Sub-specialist hospitalized patients 65 cases (specialist group). The average bed occupancy time, cost, treatment effect and satisfaction difference between the two operation modes were compared. Results The average occupancy time of bed in day group and specialist group were (1.03 ± 0.18) and (6.35 ± 0.74) days, respectively, with statistical significance (P <0.05). There were 4 postoperative complications (6.8%) in the daytime group, 4 postoperative complications (6.2%) in the specialist group, and there was no significant difference in postoperative complication rates between the two groups (P> 0.05). Satisfaction of patients in daytime group and specialist group were (96.48 ± 0.23) points and (96.53 ± 0.18) points respectively, with no significant difference (P> 0.05). The direct medical costs of day group and specialty group were (17 738.28 ± 1 027.85) and (21 307.67 ± 554.41) yuan respectively, and the direct non-medical costs were (103.39 ± 18.25) and (630.76 ± 78.90) yuan respectively. The indirect costs were (266.93 ± 47.12) and (1 640.44 ± 190.55) yuan respectively, the total costs were (18 128.10 ± 1 037.76) and (23 558.29 ± 619.20) yuan, respectively. There was significant difference between the two groups (P <0.05). The day-to-day group and specialist group’s treatment effect index were 0.96 and 1.05 respectively, and the cost-effectiveness ratios were 18 883.44 and 22 436.47, respectively. For the sensitivity analysis, the adjusted cost-effectiveness was 16 629.64 lower than that of the day group 20 534.91 of the group. Conclusion The cost-effectiveness of daytime surgery is superior to that of specialist hospitalization, and there is no difference between patient satisfaction and hospitalization. This model can be recommended for patients who meet the indications of daytime operation.