Kasatpibal Nongyao, Thongpiyapoom Somchit, Narong Montha Na, Suwalak Nonglak, Jamulitrat Silom
Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand.
J Med Assoc Thai. 2005 Aug;88(8):1083-91.
Information concerning the economic impact of surgical site infection (SSI) is very rare in Thailand. As the national health care financial system has been changing, the need for such data is critical.
The purpose of this study is to estimate the extra charge and excess postoperative hospitalization attributable to SSI in six surgical operative procedures comprising appendectomy, herniorrhaphy, mastectomy, cholecystectomy, colectomy, and craniotomy.
The study population consisted of patients undergoing major operations admitted to Songklanagarind Hospital from January, 1998 to December, 2003. Data were prospectively collected to identify demographic data, surgical operations, development of SSI, and outcomes of SSI. The study used one-to-one matched-pair strategy to compare case (patient with SSI) and controls (patient without SSI). The matching criteria were same final diagnosis, same operative procedure, and same American Society of Anesthesiologists (ASA) score. Data were calculated for mean difference, median difference, and 95% confidence intervals (95% C.I) of hospital charge and postoperative stay.
The study could identify 140 matched-pairs of case and control. When compared to matched controls, cases had higher hospital charge and greater postoperative length of stay. Mean of extra hospital charge attributable to SSI was 43,658 (95% C.I; 30,228-57,088) baht and mean of excess postoperative stay was 21.3 (95% C.I; 16.6-26.0) days. Median of extra expenditure was 31,140 (95% CI; 17,327-49,081) baht and median of prolongation of postoperative stay was 14 (95% C.I, 12-18) days.
This study supports the findings of the previous published reports that patients who have SSI incur enormous excess cost and hospital stay.
在泰国，关于手术部位感染（SSI）经济影响的信息非常罕见。随着国家医疗保健金融体系的不断变化，此类数据的需求至关重要。
本研究旨在估算六种外科手术（包括阑尾切除术、疝修补术、乳房切除术、胆囊切除术、结肠切除术和开颅手术）中，因SSI导致的额外费用和术后住院时间延长情况。
研究人群包括1998年1月至2003年12月在宋卡纳卡林医院接受大手术的患者。前瞻性收集数据以确定人口统计学数据、外科手术、SSI的发生情况以及SSI的结局。本研究采用一对一匹配对策略比较病例组（发生SSI的患者）和对照组（未发生SSI的患者）。匹配标准为相同的最终诊断、相同的手术操作以及相同的美国麻醉医师协会（ASA）评分。计算医院费用和术后住院时间的平均差异、中位数差异以及95%置信区间（95% C.I）。
本研究能够确定140对匹配的病例组和对照组。与匹配的对照组相比，病例组的医院费用更高，术后住院时间更长。因SSI导致的额外医院费用平均为43,658泰铢（95% C.I；30,228 - 57,088），术后额外住院时间平均为21.3天（95% C.I；16.6 - 26.0）。额外支出的中位数为31,140泰铢（95% CI；17,327 - 49,081），术后住院时间延长的中位数为14天（95% C.I，12 - 18）。
本研究支持先前发表报告的结果，即发生SSI的患者会产生巨大的额外费用和住院时间延长。
