日间模式下腔静脉滤器取出术的安全性与住院费用构成分析
作者:
通讯作者:
作者单位:

1.大连医科大学附属第一医院,血管外科,辽宁 大连 116011;2.大连医科大学附属第一医院,日间手术中心,辽宁 大连 116011

作者简介:

吴松,大连医科大学附属第一医院住院医师,主要从事血管外科方面的研究(

基金项目:


Analysis of the safety and hospitalization cost composition of retrieval of inferior vena cava filters in a day surgery setting
Author:
Affiliation:

1.Department of Vascular Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China;2.Department of Day Surgery Center, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 音频文件
  • |
  • 视频文件
    摘要:

    背景与目的 2022年2月,国家卫生健康委办公厅关于印发日间手术推荐目录(2022年版)的通知,其中并未纳入下腔静脉滤器取出术。本文分析笔者医院日间手术和常规住院行下腔静脉滤器取出的临床特征、中期结局和住院费用构成,探讨将日间模式应用于这一术式的安全性与合理性。方法 回顾性分析2017年5月—2022年8月大连医科大学附属第一医院行下腔静脉滤器取出术的229例患者资料,其中,91例患者采用日间模式下腔静脉滤器取出术(日间模式组),138例常规住院行滤器取出术(常规住院组)。比较两组患者一般资料、并发症及随访结果,并使用结构变动分析法统计费用明细。结果 两组间抗凝血酶与丙氨酸氨基转移酶水平有明显差异(均P<0.05),但均值都位于正常范围内,其余基线特征均无明显差异(均P>0.05)。两组的手术成功率与手术时间均无明显差异(均P>0.05)。两组的住院时间与住院费用有明显差异(均P<0.05),日间模式组所有患者均在48 h内出院,中位住院时间1.6 d,常规住院组最长15 d,中位住院时间6.0 d。日间模式组住院人均标准金额22 547.1元,比常规住院组减少8 153.1元,其中材料费结构变动贡献率30.57%,降幅11.4%;药品费结构变动贡献率25.81%,降幅62.7%;治疗费结构变动贡献率19.4%,降幅9.7%。相对于常规住院,日间模式药占比降低6.9个百分点(7.16% vs. 14.10%,P<0.001)。两组围术期并发症发生率差异无统计学意义(P>0.05)。中位随访时间23(1~64)个月,两组结局事件(症状型肺栓塞复发、下肢深静脉血栓复发或加重、全因死亡率)差异均无统计学意义(均P<0.05)。结论 日间模式下腔静脉滤器取出术是安全可行的,而且相对于传统住院模式,能明显降低药品费与药占比,在公立医院考核中可以起到积极作用。

    Abstract:

    Background and Aims In February 2022, the General Office of the National Health Commission issued a notice regarding the publication of the Recommended Catalog for for Day Surgery (2022 edition), in which the procedure for the retrieval of the inferior vena cava filters was not included. This study was conducted to analyze clinical characteristics, mid-term outcomes, and hospitalization cost composition of day surgery retrieval and conventional inpatient retrieval of inferior vena cava filters at the authors' hospital, to assess the safety and feasibility of performing this procedure this procedure in day surgery mode.Methods The data of 229 patients who underwent inferior vena cava filter retrieval in the First Affiliated Hospital of Dalian Medical University from May 2017 to August 2022 were retrospectively analyzed. Among them, 91 patients underwent day surgery retrieval (day surgery group), while 138 patients underwent conventional inpatient retrieval (conventional inpatient group). The general information, complications, follow-up results, and cost details were compared between the two groups of patients, and cost details were analyzed using the structural change analysis method.Results There were significant differences in anticoagulant and alanine aminotransferase levels between the two groups (both P<0.05), but the means were within the normal range, and other baseline characteristics showed no significant differences (all P>0.05). There were no significant differences in the success rate and operative time between the two groups (both P>0.05). However, there were significant differences in hospitalization duration and costs (both P<0.05). All patients in the day surgery group were discharged within 48 h, with a median hospital stay of 1.6 d, while the conventional inpatient group had a maximum hospital stay of 15 d, with a median stay of 6.0 d. The average standard amount per capita for hospitalization in the day surgery group was 22 547.1 yuan, a reduction of 8 153.1 yuan compared to the conventional inpatient group. The contribution rate of structure variation for material costs were 30.57%, with a decrease of 11.4%; for drug costs was 25.81%, with a decrease of 62.7%; for treatment costs, the contribution rate was 19.4%, with a decrease of 9.7%. Compared to conventional inpatient care, the proportion of drug costs in the day surgery mode decreased by 6.9 percentage points (7.16% vs. 14.10%, P<0.001). There was no statistically significant difference in the incidence of perioperative complications between the two groups (P<0.05). The median follow-up time was 23 (1-64) months, and there were no statistically significant differences in outcome events (recurrence of symptomatic pulmonary embolism, recurrence or exacerbation of deep vein thrombosis in the lower limbs, and all-cause mortality) between the two groups (all P>0.05).Conclusion The retrieval of inferior vena cava filters in a day surgery setting is safe and feasible. Moreover, compared to the traditional inpatient mode, it significantly reduces drug costs and the percentage of drug expenses. This approach can play a positive role in the appraisal system of public hospitals.

    表 2 两组患者住院费用明细结构变动分析[元(占比)]Table 2 Analysis of structural changes in detailed hospitalization costs between the two groups of patients [yuan (percentage)]
    图1 两组患者住院费用明细比较Fig.1 Comparison of detailed hospitalization costs between the two groups of patients
    图2 两组患者住院费用明细占比比较Fig.2 Comparison of the detailed percentage breakdown of hospitalization costs between the two groups of patients
    图3 两组患者结局事件比较Fig.3 Comparison of outcome events between the two groups of patients
    参考文献
    相似文献
    引证文献
引用本文

吴松,魏国栋,宋泽,谢旭,王磊,张振,夏玉桐,亓明.日间模式下腔静脉滤器取出术的安全性与住院费用构成分析[J].中国普通外科杂志,2023,32(12):1927-1935.
DOI:10.7659/j. issn.1005-6947.2023.12.012

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2022-10-28
  • 最后修改日期:2023-05-30
  • 录用日期:
  • 在线发布日期: 2024-01-09