Schuster Martin, Gottschalk André, Freitag Marc, Standl Thomas
Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Anesth Analg. 2004 Mar;98(3):708-13, table of contents. doi: 10.1213/01.ane.0000096040.02725.74.
In this retrospective study, we determined efficiency, treatment length, and resource use for postoperative pain management with patient-controlled epidural analgesia (PCEA) in 350 consecutive patients undergoing major abdominal, thoracic, gynecological, or orthopedic surgery. Average pain scores on a visual analog scale were 16 +/- 23 and 9 +/- 16 (visual analog scale range, 0 to 100) on postoperative Days 1 and 3, respectively, and were similar among groups. The treatment length was 4.9 +/- 2.2 days in general surgical, 5.2 +/- 3.1 days in gynecological, and 4.5 +/- 2.8 days in orthopedic patients. The total volumes of the mixture of local anesthetic and opioid received epidurally were 707 +/- 507 mL, 770 +/- 576 mL, and 593 +/- 456 mL in the general surgical, gynecological, and orthopedic groups, respectively. The average total costs for all groups for the full treatment course with PCEA were 447 +/- 218 per case (1 equals approximately US dollar 1). Fifty-one percent of these costs were staff costs, 20% were costs for the applied drugs, 15% were costs for PCEA pumps and pump material, and 13% were costs for the initial catheter insertion. In the light of these costs and the availability of less costly alternatives, measurements for cost containment by using PCEA are recommended. Because treatment length is the main cost driver both for drug and staff costs, close monitoring of treatment length and a predefined migration path to alternative techniques after PCEA should be considered.
Patient-controlled epidural analgesia is increasingly used as first-line treatment for postoperative pain management. In this study, costs and cost drivers are analyzed for the first time for this new technique, based on 350 cases of pain therapy after major surgery in a university hospital.
在这项回顾性研究中，我们确定了350例接受腹部、胸部、妇科或骨科大手术的连续患者采用患者自控硬膜外镇痛（PCEA）进行术后疼痛管理的效率、治疗时长和资源使用情况。术后第1天和第3天，视觉模拟量表的平均疼痛评分分别为16±23和9±16（视觉模拟量表范围为0至100），且各组之间相似。普通外科患者的治疗时长为4.9±2.2天，妇科患者为5.2±3.1天，骨科患者为4.5±2.8天。普通外科、妇科和骨科组硬膜外接受的局部麻醉药和阿片类药物混合液总量分别为707±507 mL、770±576 mL和593±456 mL。所有组采用PCEA进行整个治疗过程的平均总成本为每例447±218（1约等于1美元）。这些成本中，51%为人员成本，20%为所用药物成本，15%为PCEA泵及泵材料成本，13%为初始导管插入成本。鉴于这些成本以及存在成本更低的替代方法，建议采取措施控制使用PCEA的成本。由于治疗时长是药物和人员成本的主要驱动因素，应考虑密切监测治疗时长，并在PCEA后采用预先确定的向替代技术过渡的方案。
患者自控硬膜外镇痛越来越多地被用作术后疼痛管理的一线治疗方法。在本研究中，基于大学医院350例大手术后疼痛治疗病例，首次对这项新技术的成本及成本驱动因素进行了分析。
