临床小儿外科杂志2024，Vol.23Issue(10)：910-917,8.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
Efficacy and health economic evaluation of day surgery for pediatric inguinal hernia and hydrocele
摘要
Abstract
Objective To explore the efficacy and health economic value of day surgery for pediatric in-guinal hernia and hydrocele at Kunming Children's Hospital over the past 5 years.Methods This retrospective study collected clinical data from 4094 pediatric patients with inguinal hernia and hydrocele treated at the De-partment of Urology,Children's Hospital Affiliated to Kunming Medical University from January 2018 to Decem-ber 2022.The patients were divided into a Day Surgery Group(n=2 327)and an Inpatient Group(n=1 767)based on their treatment in the day surgery center or urology ward.The Day Surgery Group was further Inguinal Hernia Day Surgery(Group A,n=870)and Hydrocele Day Surgery Group(Group C,n=1 457).The Inpa-tient Group was divided into Inguinal Hernia Inpatient Group(Group B,n=777)and Hydrocele Inpatient Group(Group D,n=990).The two surgical modalities were compared in terms of general patient data,length of hospital stay,hospitalization costs,incidence of nosocomial infection,satisfaction,and postoperative complica-tions.Cost,effect index(EI),and cost-effectiveness ratio(CER)were also analyzed for both surgical modali-ties.Results In the intragroup comparisons,no statistically significant differences were found between the paired groups regarding postoperative fever or vomiting,incision bleeding or infection requiring medical treat-ment,recurrence,or new contralateral occurrence(P＞0.05).The average age in Groups A and B was 4.43±2.85 years and 3.58±2.82 years,respectively,and in Groups C and D was 3.84±1.96 years and 3.48±2.03 years,respectively,with a statistically significant difference(P＜0.05).The average hospital stay was 10.30±3.35 hours for Group A and 62.80±23.97 hours for Group B,and 10.12±4.53 hours for Group C and 62.06±25.96 hours for Group D,with statistically significant differences(P＜0.05).The average hospi-talization costs were 3 602.10±431.48 yuan for Group A and 5 226.22±585.93 yuan for Group B,and 3 592.67±387.67 yuan for Group C and 5 234.48±666.73 yuan for Group D,with statistically significant differences(P＜0.05).The average satisfaction scores were 89.50±4.95 points for Group A and 83.38±6.02 points for Group B,and 88.83±4.56 points for Group C and 84.26±5.77 points for Group D,with sta-tistically significant differences(P＜0.05).The average direct medical costs were 3 534.28±520.93 yuan for Group A and 5 372.72±785.06 yuan for Group B,and 3 468.71±519.03 yuan for Group C and 5 299.55±795.16 yuan for Group D,with statistically significant differences(P＜0.05).The average indirect costs were 63.99±20.09 yuan for Group A and 368.25±136.11 yuan for Group B,and 62.18±25.38 yuan for Group C and 368.91±149.21 yuan for Group D,with statistically significant differences(P＜0.05).The average total costs were 3 598.27±522.57 yuan for Group A and 5 740.97±866.26 yuan for Group B,and 3 530.90±523.26 yuan for Group C and 5 668.46±894.14 yuan for Group D,with statistically significant differences(P＜0.05).The proportions of ethnic minorities in Groups A and B were 20.9％and 21.0％,respectively,with no statistically significant difference(P＞0.05).However,in Groups C and D,the proportions were 18.1％and 28.8％,respectively,with a statistically significant difference(P＜0.05).The proportions of local children in Groups A and B was 67.0％and 53.5％,respectively,and 69.3％and 52.4％in Groups C and D,respectively,with statistically significant differences(P＜0.05).The proportion of children with American So-ciety of Anesthesiologists(ASA)grade I in Groups A and B was 87.4％and 83.7％,respectively,and 88.8％and 83.7％in Groups C and D,respectively,with statistically significant differences(P＜0.05).The propor-tion of children with health insurance coverage in Groups A and B was 80.1％and 68.2％,respectively,and 79.4％and 68.6％in Groups C and D,respectively,with statistically significant differences(P＜0.05).The incidence of nosocomial infections in Groups A and B was 0.5％and 3.9％,respectively,and 0.3％and 3.7％in Groups C and D,respectively,with statistically significant differences(P＜0.05).The EI in Groups A and B was 0.98 and 1.03,respectively,with CERs of 3671.70 and 5 573.75,respectively.In Groups C and D,the EI was 0.99 and 1.02,with CERs of 3 566.56 and 5 557.31,respectively.Conclusions Day surgery can significantly reduce hospital stay,hospitalization costs,nosocomial infection rates,and medical costs while im-proving family satisfaction,offering higher health economic benefits.关键词
腹股沟斜疝/鞘膜积液/卫生经济学/外科手术/儿童Key words
Oblique Inguinal Hernia/Hydrocele/Health Economics/Surgical Procedures,Operative/Child引用本文复制引用
王志伟,张黄成昊,姚桂萍,毛睿,窦红昆,刘灵芝,计凤鸣,夭志刚,严兵..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[J].临床小儿外科杂志,2024,23(10):910-917,8.基金项目
云南省教育厅科学研究基金(2023J0295) （2023J0295）
云南省科技厅昆医联合专项-面上项目(202301AY070001-108) Yunan Provincial Department of Education Scientific Research Fund(2023J0295) （202301AY070001-108）
Joint Project of Yunnan Provincial Department of Science and Technology and Kunming Medical University(202301AY070001-108) （202301AY070001-108）
