El Kafsi J, Wake J, Lintott P, Northeast A, McLaren A
Department of General Surgery, Stoke Mandeville Hospital, Aylesbury, UK.
Ann R Coll Surg Engl. 2009 Nov;91(8):645-8. doi: 10.1308/003588409X12486167521037. Epub 2009 Sep 25.
The aims of this study were to audit the outcome of elective open abdominal aortic aneurysm (AAA) repair in a district general hospital, as well as investigate the true costs for this procedure in relation to the national tariff.
A database is maintained on AAA surgery in the trust. Data were supplemented by drawing information from blood bank and clinical notes. Patients with symptomatic or emergency aneurysms were excluded. Data from January 2005 to December 2007 were obtained on demographics, morbidity, 30-day mortality and blood usage. Costs were obtained from the trust finance department.
Between January 2005 and December 2007, 79 elective AAA procedures were undertaken. Median age was 75 years (range, 52-85 years), median aneurysm size was 63 mm (range, 42-105 mm) and median ITU stay was 3 days (range, 1-41 days). Major morbidity rate was 20.3% (16 of 79 patients) and 30-day mortality overall was 5.1% (4 of 79 patients). Average cost per case was pound15,012.91 (range, pound4,040.03- pound82,158.00), when National Tariff is pound6,722.00 ( pound5,649.00 x local Market Forces Factor of 1.19). Loss per case for our trust was pound8,290.91 with a total annual loss of pound218,299.56.
Morbidity and mortality in this district general hospital compare well with national studies; however, the total cost is far in excess of the national tariff.
本研究的目的是审核一家地区综合医院择期开放性腹主动脉瘤（AAA）修复手术的结果，并调查该手术相对于国家收费标准的实际成本。
信托机构维护了一个关于AAA手术的数据库。通过从血库和临床记录中提取信息对数据进行补充。排除有症状或急诊动脉瘤患者。获取了2005年1月至2007年12月期间患者的人口统计学数据、发病率、30天死亡率和用血情况。成本数据来自信托财务部门。
2005年1月至2007年12月期间，共进行了79例择期AAA手术。中位年龄为75岁（范围52 - 85岁），中位动脉瘤大小为63毫米（范围42 - 105毫米），中位重症监护病房停留时间为3天（范围1 - 41天）。主要发病率为20.3%（79例患者中的16例），总体30天死亡率为5.1%（79例患者中的4例）。每例平均成本为15,012.91英镑（范围4,040.03英镑 - 82,158.00英镑），而国家收费标准为6,722.00英镑（5,649.00英镑×当地市场调节因子1.19）。我们信托机构每例的亏损为8,290.91英镑，年度总亏损为218,299.56英镑。
这家地区综合医院的发病率和死亡率与全国性研究相比情况良好；然而，总成本远远超过国家收费标准。
