Kelly R E, Wenger A, Horton C, Nuss D, Croitoru D P, Pestian J P
Department of Surgery, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk 23507, USA.
J Pediatr Surg. 2000 Jul;35(7):1045-8. doi: 10.1053/jpsu.2000.7768.
BACKGROUND/PURPOSE: The purpose of this study is to discover whether a pediatric inguinal hernia surgical clinical pathway (CP) reduces the frequency of wound infections, return visits, times associated with surgical repair, or costs.
A multidisciplinary team developed the inguinal hernia surgical clinical pathway. Healthy children greater than 50 weeks gestational age who required unilateral hernia repair were considered for the study. Two groups were formed: (1) an intervention group selected randomly (n = 46, CI = 95%, power = .80) from patients enrolled from November 1996 through April 1997, and (2) a retrospective cohort control group (n = 46) matched to each intervention patient by age, gender, and medical history. Analysis of variance and chi2 testing were used to test for significant differences between the 2 groups in postoperative wound infections, readmission and emergency department return visits within 72 hours, times associated with surgical repair, and costs.
There were no significant differences in postoperative wound infections, times associated with surgical repair, or readmission rates within 72 hours. Total cost significantly decreased, by 10% (P< or = .05), for pathway patients ($982 v $880).
These results show that the use of a pediatric inguinal hernia surgical clinical pathway is associated with reduced cost while maintaining quality of care.
背景/目的：本研究旨在探究小儿腹股沟疝手术临床路径（CP）是否能降低伤口感染频率、复诊率、手术修复相关时间或成本。
一个多学科团队制定了腹股沟疝手术临床路径。纳入研究的对象为孕周大于50周且需要进行单侧疝修补术的健康儿童。研究分为两组：（1）干预组，从1996年11月至1997年4月登记的患者中随机选取（n = 46，CI = 95%，检验效能 = 0.80）；（2）回顾性队列对照组（n = 46），根据年龄、性别和病史与每名干预组患者进行匹配。采用方差分析和卡方检验来检测两组在术后伤口感染、72小时内再次入院和急诊复诊、手术修复相关时间以及成本方面的显著差异。
术后伤口感染、手术修复相关时间或72小时内再次入院率方面，两组无显著差异。路径组患者的总成本显著降低了10%（P≤0.05）（982美元对880美元）。
这些结果表明，采用小儿腹股沟疝手术临床路径在维持医疗质量的同时降低了成本。
