经鼻蝶窦入路垂体瘤术后颅内感染的经济损失分析
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摘要
目的分析颅内感染对经鼻蝶窦入路垂体瘤患者住院费用和住院天数的影响,为医院感染防控提供卫生经济学支持。方法回顾调查2012年1月-2018年10月神经外科进行经鼻蝶窦入路垂体瘤切除且术后发生颅内感染患者31例,采用1∶1匹配病例对照研究方法纳入31例未发生颅内感染患者,比较两组患者住院费用和住院天数的差异。结果感染组和对照组的中位住院总费用分别为52 756、23 153元,额外经济损失为29 603元,两组差异有统计学意义(Z=-6.624,P=0.001)。分类住院费用中,感染组和对照组护理费、西药费、抗菌药物费、一般治疗操作费、诊断和检查费、耗材费差异均有统计学意义。感染组患者住院天数(中位数)为10天,对照组则为5天,(中位数)增加5天,差异有统计学意义(Z=-5.996,P=0.001)。结论经鼻蝶窦入路垂体瘤术后发生颅内感染不仅延长患者住院天数,还造成显著的经济损失,今后应采取有效管理方法控制相关感染。
OBJECTIVE To observe the influence of intracranial infection on hospitalization cost and length of hospital stay of the patients undergoing endonasal transsphenoidal surgery for pituitary tumor so as to provide health economic support for prevention and control of nosocomial infection. METHODS A total of 31 patients who underwent endonasal transsphenoidal surgery for pituitary tumor in neurosurgery department from Jan 2012 to Oct 2018 and had postoperative intracranial infection were retrospectively investigated, and 31 patients who did not have intracranial infection were included in a 1∶1 ratio by means of case-control method. The hospitalization cost and length of hospital stay were observed and compared between the two groups of patients. RESULTS The median total hospitalization cost of the infection group was 52 756 yuan, the control group 23 153 yuan, with the extra economic loss 29 603 yuan, and there was significant difference between the two groups(Z=-6.624,P=0.001). As compared with the classified hospitalization costs, there were significant differences in nursing cost, western medicine cost, cost of antibiotics, general treatment cost, cost of diagnosis and treatment and cost of consumable items between the infection group and the control group. The median length of hospital stay of the infection group was 10 day, the control group 5 days, with the increase(median) 5 days, and there was significant difference(Z=-5.996,P=0.001). CONCLUSION The postoperative intracranial infection may not only extend the length of hospital stay of the patients undergoing endonasal transsphenoidal surgery for pituitary tumor but also result in the economic loss, and it is necessary to take effective measures for control of the infection.
OBJECTIVE To observe the influence of intracranial infection on hospitalization cost and length of hospital stay of the patients undergoing endonasal transsphenoidal surgery for pituitary tumor so as to provide health economic support for prevention and control of nosocomial infection. METHODS A total of 31 patients who underwent endonasal transsphenoidal surgery for pituitary tumor in neurosurgery department from Jan 2012 to Oct 2018 and had postoperative intracranial infection were retrospectively investigated, and 31 patients who did not have intracranial infection were included in a 1∶1 ratio by means of case-control method. The hospitalization cost and length of hospital stay were observed and compared between the two groups of patients. RESULTS The median total hospitalization cost of the infection group was 52 756 yuan, the control group 23 153 yuan, with the extra economic loss 29 603 yuan, and there was significant difference between the two groups(Z=-6.624,P=0.001). As compared with the classified hospitalization costs, there were significant differences in nursing cost, western medicine cost, cost of antibiotics, general treatment cost, cost of diagnosis and treatment and cost of consumable items between the infection group and the control group. The median length of hospital stay of the infection group was 10 day, the control group 5 days, with the increase(median) 5 days, and there was significant difference(Z=-5.996,P=0.001). CONCLUSION The postoperative intracranial infection may not only extend the length of hospital stay of the patients undergoing endonasal transsphenoidal surgery for pituitary tumor but also result in the economic loss, and it is necessary to take effective measures for control of the infection.
引文
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[18] 郭轶斌,郭威,邱佩琪,等.多药耐药与非耐药鲍曼不动杆菌院内感染的归因住院费用与住院时长研究[J].中国卫生统计,2017,34(3):378-381.
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[21] Sherrod BA,Johnston JM,Rocque BG.Risk factors for unplanned readmission within 30 days after pediatric neurosurgery:a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program[J].J Neurosurg Pediatr,2016,18(3):350-362.
[22] 刘宏,贺凤义,马永辉,等.神经外科手术部位感染的经济损失[J].中国感染控制杂志,2018,17(7):619-622.
[2] Zhou J,Ma X.Cost-benefit analysis of craniocerebral surgical site infection control in tertiary hospitals in China[J].J Infect Dev Ctries,2015,9(2):182-189.
[3] Zimlichman E,Henderson D,Tamir O,et al.Health care-associated infections:a meta-analysis of costs and financial impact on the US health care system[J].JAMA Intern Med,2013,173(22):2039-2046.
[4] Davies BM,Jones A,Patel HC.Implementation of a care bundle and evaluation of risk factors for surgical site infection in cranialneurosurgery[J].Clin Neurol Neurosurg,2016,144:121-125.
[5] Koch AM,Nilsen RM,Eriksen HM,et al.Mortality related to hospital-associated infections in a tertiary hospital;repeated cross-sectional studies between 2004-2011[J].Antimicrob Resist Infect Control,2015,4:57.
[6] Agam MS,Wedemeyer MA,Wrobel B,et al.Complications associated with microscopic and endoscopic transsphenoidal pituitary surgery:experience of 1153 consecutive cases treated at a single tertiary care pituitary center[J].J Neurosurg,2018,1-8.
[7] Lawrence LA,Baker AB,Nguyen SA,et al.Predictors of 30-day morbidity and mortality in transnasal microscopic pituitary tumor excision[J].Int Forum Allergy Rhinol,2016,6(2):206-213.
[8] 倪健,吉莉,钱晓英,等.经鼻蝶窦入路垂体瘤切除术后并发颅内感染相关因素分析[J].中华医院感染学杂志,2018,28(12):1849-1851.
[9] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[10] Lobatto DJ,de Vries F,Zamanipoor Najafabadi AH,et al.Preoperative risk factors for postoperative complications in endoscopic pituitary surgery:a systematic review[J].Pituitary,2018,21(1):84-97.
[11] Cole TS,Clark ME,Jenkins AJ,et al.Pediatric focal intracranial suppuration:a UK single-center experience[J].Childs Nerv Syst,2012,28(12):2109-2114.
[12] O'Brien K,Leach J,Jones B,et al.Calcifications associated with pediatric intracranial arterial aneurysms:incidence and correlation with pathogenetic subtypes[J].Childs Nerv Syst,2013,29(4):643-649.
[13] 胡爱香,李静,石月欣,等.垂体瘤患者术后颅内感染影响因素与疾病负担分析[J].中华医院感染学杂志,2016,26(11):2488-2490.
[14] 贾会学,侯铁英,李卫光,等.中国68所综合医院医院感染的经济损失研究[J].中国感染控制杂志,2016,15(9):637-641.
[15] 向珮莹,莫泽珣,王艳,等.神经外科清洁手术患者医院感染的经济损失[J].中国感染控制杂志,2018,17(5):423-426.
[16] 王桂明,张开刚,李学军,等.神经外科患者手术部位感染的直接经济损失评价[J].中华医院感染学杂志,2015,25(11):2542-2544.
[17] 田晓玲,孙吉花,王玉果,等.某三级综合医院神经外科医院获得性感染经济损失评价[J].滨州医学院学报,2017,40(1):56-58.
[18] 郭轶斌,郭威,邱佩琪,等.多药耐药与非耐药鲍曼不动杆菌院内感染的归因住院费用与住院时长研究[J].中国卫生统计,2017,34(3):378-381.
[19] Bartsch SM,McKinnell JA,Mueller LE,et al.Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States[J].Clin Microbiol Infect,2017,23(1):48.e9-48.e16.
[20] Uematsu H,Yamashita K,Kunisawa S,et al.Estimating the disease burden of methicillin-resistant Staphylococcus aureus in Japan:retrospective database study of Japanese hospitals[J].PLoS One,2017,12(6):e0179767.
[21] Sherrod BA,Johnston JM,Rocque BG.Risk factors for unplanned readmission within 30 days after pediatric neurosurgery:a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program[J].J Neurosurg Pediatr,2016,18(3):350-362.
[22] 刘宏,贺凤义,马永辉,等.神经外科手术部位感染的经济损失[J].中国感染控制杂志,2018,17(7):619-622.