Comparison of health economical evaluation between ambulatory surgery and special in-hospital surgery mode for flexible ureteroscopic holmium laser lithotriphy for ureteral calculi_West China Medical Journal

Authors：

PENG Jing , WANG Shuhong , MO Yang , XIAO Yingping ,  LIU Weidong

Day Surgery Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China;

Corresponding?author：

LIU Weidong, Email: weidong.liu@csu.edu.cn

Keywords：

Day surgery; Ureteral calculi; Patients satisfaction; Cost; Cost-effectiveness; Health economical evaluation

DOI：

10.7507/1002-0179.201709206

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Objective To evaluate the ambulatory surgery mode by using health economical mothods and provide reference for optimization and decision of surgical operation mode. Methods The patients who underwent unilateral flexible ureteroscopic holmium laser lithotriphy for ureteral calculi in Xiangya Hospital, Central South University between January 1st to December 31th, 2015 were selected in this study, including 59 with ambulatory surgery mode (the ambulatory group) and 65 with special in-hospital surgery mode (the special group). The differences in average bed occupancy time, cost, therapeutic effect, and satisfaction between the two operation modes were compared. Results The average bed occupancy time in the ambulatory group and the special group was (1.03±0.18) and (6.35±0.74) days, respectively, and the difference was statistically significant (P<0.05). The patients in both groups were followed up for one month after the operation, and the incidence of complications was 6.8% (4/59) in the ambulatory group and 6.2% (4/65) in the special group, without significant difference (P>0.05). The satisfaction score in the ambulatory group and the special group was 96.48±0.23vs. 96.53±0.18 without significant difference (P>0.05). The differences in direct medical cost [(17 738.28±1 027.85)vs. (21 307.67±554.41) yuan], direct non-medical cost [(103.39±18.25) vs. (630.76±78.90) yuan], indirect cost[ (266.93±47.12) vs. (1 640.44±190.55) yuan], and total cost [(18 128.10±1 037.76) vs. (23 558.29±619.20) yuan] between the ambulatory group and the special group were all statistically significant (P<0.05). The treatment effect index in the ambulatory group and the special group was 0.96 and 1.05, respectively; the cost-effect ratio was 18 883.44 and 22 436.47, respectively. Sensitivity analysis showed that the adjusted cost-effect ratio in the ambulatory group (16 629.64) was still lower than that in the special group (20 534.91). Conclusions The cost-effect ratio of ambulatory surgery mode is superior than that of special in-hospital surgery mode, and there is no obvious difference in patients satisfaction between the two modes. Ambulatory surgery mode can be recommended to patients who meet the indications of day surgery.

Citation： PENG Jing, WANG Shuhong, MO Yang, XIAO Yingping, LIU Weidong. Comparison of health economical evaluation between ambulatory surgery and special in-hospital surgery mode for flexible ureteroscopic holmium laser lithotriphy for ureteral calculi. West China Medical Journal, 2017, 32(11): 1675-1679. doi: 10.7507/1002-0179.201709206 Copy

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11.	劉蔚東. 日間手術合理調配診療資源. 中國衛生人才, 2016(3): 27-30.
12.	何瓊, 張靜, 周維強, 等. 湖南省某院日間手術實施現狀分析. 中國病案, 2017, 18(2): 56-59.
13.	馬洪升, 戴燕. 日間手術治療模式國內外發展簡述. 中國醫院管理, 2012, 32(1): 47-48.
14.	張繼東, 聞大翔, 范關榮. 日間手術對縮短平均住院日的影響. 中國醫院管理, 2009, 29(11): 27-28.
15.	李關平, 羅艷霞, 雷靜, 等. 腹腔鏡膽囊切除術開展日間手術的可行性探討. 現代預防醫學, 2010, 37(23): 4576-4577.
16.	Ammori BJ, Davides D, Vezakis A, et al. Day-case laparoscopic cholecystectomy: a prospective evaluation of a 6-year experience. J Hepatobiliary Pancreat Surg, 2003, 10(4): 303-308.
17.	Keulemans Y, Eshuis J, de Haes H, et al. Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg, 1998, 228(6): 734-740.
18.	Ali A, Chawla T, Jamal A. Ambulatory laparoscopic cholecystectomy: is it safe and cost effective?. J Minim Access Surg, 2009, 5(5): 8-13.
19.	李良菊, 朱泉玉, 胡海燕. 經輸尿管鏡鈥激光碎石日間手術的安全及質量評價. 海南醫學, 2017, 28(1):141-143.

1. Reed WA. International Association for Ambulatory Surgery: ambulatory surgery: a worldwide concern. Ambulat Surg, 1995, 3(3): 155-160.
2. Agrawal S, Shapey I, Peacock A, et al. Prospective study of routine day-case laparoscopic modified lind partial fundoplication. World J Surg, 2009, 33(6): 1229-1234.
3. Sherigar JM, Irwin GW, Rathore MA, et al. Ambulatory laparoscopic cholecystectomy outcomes. JSLS, 2007, 10(4): 473-478.
4. Teerawattananon Y, Mugford M. Is it worth offering a routine laparoscopic cholecystectomy in developing countries? A Thailand case study. Cost Eff Resour Alloc, 2005, 3(1): 10.
5. Boothe P, Finegan BA. Changing the admission process for elective surgery: an economic analysis. Can J Anaesth, 1995, 42(5 Pt 1): 391-394.
6. 劉輝霞. 因工燒傷不同治疔方案的衛生經濟學評價. 長沙: 中南大學, 2013.
7. Ilia S, Frances C. Outcomes in day surgery. Curr Opin Anaesthesiol, 2006, 19(6): 622-629.
8. Armanious S, Chung F. Quality management in ambulatory surgery. Prob Anesth, 2001, 13: 458-467.
9. 房良, 楊麗, 李國紅, 等. 日間手術治療模式的效果評價及影響因素分析. 中國醫院, 2014(5): 34-35.
10. 王曉君. 胃癌術后序貫性早期腸內營養支持的臨床效果及衛生經濟學評價. 南京: 南京醫科大學, 2014.
11. 劉蔚東. 日間手術合理調配診療資源. 中國衛生人才, 2016(3): 27-30.
12. 何瓊, 張靜, 周維強, 等. 湖南省某院日間手術實施現狀分析. 中國病案, 2017, 18(2): 56-59.
13. 馬洪升, 戴燕. 日間手術治療模式國內外發展簡述. 中國醫院管理, 2012, 32(1): 47-48.
14. 張繼東, 聞大翔, 范關榮. 日間手術對縮短平均住院日的影響. 中國醫院管理, 2009, 29(11): 27-28.
15. 李關平, 羅艷霞, 雷靜, 等. 腹腔鏡膽囊切除術開展日間手術的可行性探討. 現代預防醫學, 2010, 37(23): 4576-4577.
16. Ammori BJ, Davides D, Vezakis A, et al. Day-case laparoscopic cholecystectomy: a prospective evaluation of a 6-year experience. J Hepatobiliary Pancreat Surg, 2003, 10(4): 303-308.
17. Keulemans Y, Eshuis J, de Haes H, et al. Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg, 1998, 228(6): 734-740.
18. Ali A, Chawla T, Jamal A. Ambulatory laparoscopic cholecystectomy: is it safe and cost effective?. J Minim Access Surg, 2009, 5(5): 8-13.
19. 李良菊, 朱泉玉, 胡海燕. 經輸尿管鏡鈥激光碎石日間手術的安全及質量評價. 海南醫學, 2017, 28(1):141-143.

West China Medical Journal

Comparison of health economical evaluation between ambulatory surgery and special in-hospital surgery mode for flexible ureteroscopic holmium laser lithotriphy for ureteral calculi

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