Wang Zhiwei,Zhang Huangchenghao,Yao Guiping,et al.Efficacy and health economic evaluation of day surgery for pediatric inguinal hernia and hydrocele[J].Journal of Clinical Pediatric Surgery,2024,(10):910-917.[doi:10.3760/cma.j.cn101785-2024070536-003]
小儿腹股沟斜疝及鞘膜积液日间手术疗效与卫生经济学评价
- Title:
- Efficacy and health economic evaluation of day surgery for pediatric inguinal hernia and hydrocele
- Keywords:
- Oblique Inguinal Hernia; Hydrocele; Health Economics; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨小儿腹股沟斜疝和鞘膜积液日间手术的疗效及卫生经济学价值。方法 本研究为回顾性研究, 收集昆明市儿童医院泌尿外科自2018年1月至2022年12月收治的小儿腹股沟斜疝及鞘膜积液4 094例作为研究对象。根据患儿在日间诊疗中心或泌尿外科病房手术治疗情况, 分为日间组(n=2 327)和住院组(n=1 767);根据病种将日间组分为腹股沟斜疝日间组(A组, n=870)和鞘膜积液日间组(C组, n=1 457), 将住院组分为腹股沟斜疝住院组(B组, n=777)和鞘膜积液住院组(D组, n=990)。将4个亚组配为2对(A组&B组、C组&D组), 比较两种手术模式下患儿一般资料、住院时间、住院费用、院内感染、满意度和术后并发症的差异, 并分析两种手术模式的成本、治疗效果指数(effect index, EI)和成本效果比(cost-effectiveness ratio, CER)。结果 以上2对进行组内比较显示, 术后发生发热或呕吐、需医疗机构处理的切口渗血或感染、复发和对侧新发情况差异无统计学意义(P＞0.05);A、B组年龄分别为(4.43±2.85)岁和(3.58±2.82)岁, C、D组的年龄分别为(3.84±1.96)岁和(3.48±2.03)岁, 差异均有统计学意义(P<0.05)。A、B组住院时间分别为(10.30±3.35)h和(62.80±23.97)h, C、D组住院时间分别为(10.12±4.53)h和(62.06±25.96)h, 差异均有统计学意义(P<0.05)。A、B组住院费用分别为(3 602.10±431.48)元和(5 226.22±585.93)元;C、D组住院费用分别(3 592.67±387.67)元和(5 234.48±666.73)元, 差异均有统计学意义(P<0.05)。A、B组的满意度评分分别为(89.50±4.95)分和(83.38±6.02)分, C、D组的满意度评分分别为(88.83±4.56)分和(84.26±5.77)分, 差异均有统计学意义(P<0.05)。A、B组直接医疗成本分别为(3 534.28±520.93)元和(5 372.72±785.06)元, C、D组直接医疗成本分别为(3 468.71±519.03)元和(5 299.55±795.16)元, 差异均有统计学意义(P<0.05)。A、B组间接成本分别为(63.99±20.09)元和(368.25±136.11)元, C、D组间接成本分别为(62.18±25.38)元和(368.91±149.21)元, 差异均有统计学意义(P<0.05)。A、B组总成本分别为(3 598.27±522.57)元和(5 740.97±866.26)元, C、D组总成本分别为(3 530.90±523.26)元和(5 668.46±894.14)元, 差异均有统计学意义(P<0.05)。A、B组的少数民族人数占比分别为20.9%和21.0%, 差异无统计学意义(P＞0.05);而C、D组少数民族人数占比分别为18.1%和28.8%, 差异有统计学意义(P<0.05)。A、B组本市患儿占比分别为67.0%和53.5%, C、D组本市患儿占比分别为69.3%和52.4%, 差异有统计学意义(P<0.05)。A、B组麻醉评估分级(American Society of Anesthesiologists, ASA)为Ⅰ级人数比例分别为87.4%和83.7%;C、D组的ASA分级为Ⅰ级人数占比分别为88.8%和83.7%;差异均有统计学意义(P<0.05)。A、B组医保支付比例分别为80.1%和68.2%;C、D组医保支付比例分别为79.4%和68.6%, 差异均有统计学意义(P<0.05)。A、B组院内感染发生率分别为0.5%和3.9%, C、D组的院内感染发生率分别为0.3%和3.7%;差异均有统计学意义(P<0.05)。A、B组EI分别为0.98、1.03, CER分别为3 671.70、5 573.75;C、D组EI分别为0.99、1.02, CER分别为3 566.56、5 557.31。结论 日间手术在同样治疗效果的情况下, 可以明显减少住院时间、住院费用、院内感染的发生和医疗成本, 并提高患儿家属满意度, 有更高的卫生经济学效益。
参考文献/References:
[1] Morini F, Dreuning KMA, Janssen Lok MJH, et al.Surgical management of pediatric inguinal hernia:a systematic review and guideline from the European Pediatric Surgeons’ Association Evidence and Guideline Committee[J].Eur J Pediatr Surg, 2022, 32(3):219-232.DOI:10.1055/s-0040-1721420.
[2] Poenaru D.Inguinal hernias and hydroceles in infancy and childhood:a consensus statement of the Canadian Association of Paediatric Surgeons[J].Paediatr Child Health, 2000, 5(8):461-462.DOI:10.1093/pch/5.8.461.
[3] Hall NJ, Ron O, Eaton S, et al.Surgery for hydrocele in children-an avoidable excess?[J].J Pediatr Surg, 2011, 46(12):2401-2405.DOI:10.1016/j.jpedsurg.2011.07.029.
[4] Jobson M, Hall NJ.Current practice regarding timing of patent processus vaginalis ligation for idiopathic hydrocele in young boys:a survey of UK surgeons[J].Pediatr Surg Int, 2017, 33(6):677-681.DOI:10.1007/s00383-017-4085-4.
[5] Saka R, Okuyama H, Sasaki T, et al.Safety and efficacy of laparoscopic percutaneous extraperitoneal closure for inguinal hernias and hydroceles in children:a comparison with traditional open repair[J].J Laparoendosc Adv Surg Tech A, 2014, 24(1):55-58.DOI:10.1089/lap.2013.0109.
[6] Peng YH, Li CQ, Lin WB, et al.Application of a laparoscopic, single-port, double-needle technique for pediatric hydroceles with multiple peritoneal folds:a trial from a single-center 5-year experience[J].Urology, 2015, 85(6):1466-1470.DOI:10.1016/j.urology.2015.01.053.
[7] 卫生经济学会.日间手术定义.[2021-12-28].http://www.chinaasa.org/col.jsp?id=134. Society for Health Economics.Definition of day surgery.[2021-12-28].http://www.chinaasa.org/col.jsp?id=134.
[8] 金同阳.艾考恩丙替与传统一线方案治疗艾滋病的卫生经济学评价.北京:北京中医药大学, 2023. Jin TY.Health economic evaluation of iconoprofen and traditional first-line regimen in the treatment of AIDS.Beijing:Beijing University of Chinese Medicine, 2023.
[9] 刘辉霞.因工烧伤不同治疗方案的卫生经济学评价.长沙:中南大学, 2013. Liu HX.Health economic evaluation of different therapeutic regimens for the work burn patients.Changsha:Central South University, 2013.
[10] 金鑫, 王佚, 刘俊宏, 等.小儿腹股沟斜疝日间手术与专科住院手术的卫生经济学评价[J].中华小儿外科杂志, 2020, 41(1):69-74.DOI:10.3760/cma.j.issn.0253-3006.2020.01.015. Jin X, Wang Y, Liu JH, et al.Comparison of health economical evaluation between day surgery and inpatient hospitalization surgery mode for inguinal hernia[J].Chin J Pediatr Surg, 2020, 41(1):69-74.DOI:10.3760/cma.j.issn.0253-3006.2020.01.015.
[11] Burns LA, Ferber MS.Ambulatory surgery in the United States:development and prospects[J].J Ambul Care Manage, 1981, 4(3):1-13.DOI:10.1097/00004479-198108000-00003.
[12] Letts M, Davidson D, Splinter W, et al.Analysis of the efficacy of pediatric day surgery[J].Can J Surg, 2001, 44(3):193-198.
[13] 鲍益耀, 胡书奇, 黄寿奖, 等.中国小儿日间手术发展的基本现状调查与思考[J].中华小儿外科杂志, 2020, 41(8):692-697.DOI:10.3760/cma.j.cn421158-20200228-00127. Bao YY, Hu SQ, Huang SJ, et al.Current status and development of pediatric ambulatory surgery in China[J].Chin J Pediatr Surg, 2020, 41(8):692-697.DOI:10.3760/cma.j.cn421158-20200228-00127.
[14] Caredda E, Guolo S, Rinaldi S, et al.Outpatient surgery is the solution at hand for reducing costs and hospital stays for pediatric surgery too:a hospital trial[J].Minerva Pediatr, 2020, 72(2):101-108.DOI:10.23736/S0026-4946.19.05426-4.
[15] Poves-álvarez R, Gómez-Sánchez E, Martínez-Rafael B, et al.Parental satisfaction with autonomous pediatric ambulatory surgery units[J].Qual Manag Health Care, 2021, 30(3):145-152.DOI:10.1097/QMH.0000000000000301.
相似文献/References:
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备注/Memo
收稿日期:2024-6-29。
基金项目:云南省教育厅科学研究基金(2023J0295);云南省科技厅昆医联合专项-面上项目(202301AY070001-108)
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