Baker Jannah, Windsor John
Department of General Surgery, Auckland City Hospital, Auckland, New Zealand.
N Z Med J. 2009 May 22;122(1295):37-46.
Reduction in length of inpatient stay is an important factor in reducing healthcare costs in many hospital systems. This paper examines trends in hospital stay over time for general surgical patients presenting with abscess, and outlines the potential benefits if a day case service for acute abscess procedures was established.
Retrospective review of Otago Surgical Audit data from 1992 to 2007 yielded clinical data for 2475 adult general surgical cases at Auckland City Hospital with a primary or secondary diagnosis of abscess. A subset of patients potentially suitable for day case surgical procedures was analysed.
A steady increase in numbers of abscess cases treated by the Department of General Surgery was seen from 1992 to 2007. The most common types of superficial abscess were cutaneous (47%), perianal (40%), and breast (13%). Fifty-nine percent of general surgical hospital admissions in this series could potentially have been treated on a day case basis, but only 6% were actually treated as day cases. A median duration of inpatient stay of two days was required for a mean procedure duration of 16 minutes. A total of 1357 (90%) patients had a total hospital stay of more than 24 hours in the potential day case group. This accounted for 2338 bed days over the 15-year study period, or an average of 359 bed days per annum. For the most recent three-year period, the average total cost of each acute superficial abscess admission for less than seven days was $4440. The average cost for a patient treated as a day case was $1389, indicating a potential saving of $3501 per patient if a day case service had been available.
This study identifies a common problem which is being managed suboptimally in our hospital. Day case management of appropriate patients with acute superficial abscess would result in significant cost savings, decrease hospital bed occupancy and improve patient care.
缩短住院时间是许多医院系统降低医疗成本的一个重要因素。本文研究了因脓肿就诊的普通外科患者住院时间随时间的变化趋势，并概述了建立急性脓肿手术日间手术服务可能带来的益处。
对1992年至2007年奥塔哥外科审计数据进行回顾性分析，获得了奥克兰市医院2475例主要或次要诊断为脓肿的成人普通外科病例的临床数据。对一部分可能适合日间手术的患者进行了分析。
1992年至2007年，普通外科治疗的脓肿病例数量稳步增加。最常见的浅表脓肿类型为皮肤脓肿（47%）、肛周脓肿（40%）和乳腺脓肿（13%）。本系列中59%的普通外科住院患者可能适合日间手术治疗，但实际仅6%作为日间手术治疗。平均手术时间为16分钟，住院时间中位数为两天。在可能适合日间手术的患者组中，共有1357例（90%）患者住院时间超过24小时。在15年的研究期间，这占用了2338个床位日，平均每年359个床位日。在最近的三年期间，每例急性浅表脓肿住院时间少于七天的平均总费用为4440美元。日间手术患者的平均费用为1389美元，这表明如果有日间手术服务，每位患者可能节省3501美元。
本研究发现了我院存在的一个未得到最佳管理的常见问题。对合适的急性浅表脓肿患者进行日间手术管理将显著节省成本、减少医院床位占用并改善患者护理。
