溃疡性结肠炎直肠结肠切除术前及术后长期直接费用：明尼苏达州奥姆斯特德县的一项基于人群的研究。
Long-term direct costs before and after proctocolectomy for ulcerative colitis: a population-based study in Olmsted County, Minnesota.
机构信息
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
出版信息
Dis Colon Rectum. 2009 Nov;52(11):1815-23. doi: 10.1007/DCR.0b013e3181b327a6.
PURPOSE
This study was designed to test the hypothesis that patients undergoing definitive surgery for chronic ulcerative colitis have reduced direct medical costs after, as compared with before, total proctocolectomy.
METHODS
A population-based cohort of patients who underwent proctocolectomy for ulcerative colitis from 1988 to 2007 was identified using the Rochester Epidemiology Project. Total direct healthcare costs were estimated from an administrative database. The primary outcome was the observed cost difference between the two-year period before surgery and the two-year period after a surgery/recovery period (surgery + 180 days). Statistical significance was assessed using paired t-tests and bootstrapping methods. Demographic data were presented as median (interquartile range) or frequency (proportion). Mean costs are reported in 2007 constant dollars.
RESULTS
Sixty patients were Olmsted County, Minnesota, residents at the time of surgery and for the entire period of observation. Overall 40 patients (66%) were men, median age was 42 (range, 31-52) years, and duration of median colitis was four (range, 1-11) years. Operations included ileal pouch-anal anastomosis (n = 45, mean cost of surgery/recovery period = $50,530) and total proctocolectomy with Brooke ileostomy (n = 15, mean cost of surgery/recovery period = $39,309). In the pouch subgroup, direct medical costs on average were reduced by $9,296 (P < 0.001, bootstrapped 95% confidence interval: $324-$15,628) during the two years after recovery. In the Brooke ileostomy subgroup, direct medical costs on average were reduced by $12,529 (P < 0.001, bootstrapped 95% confidence interval: $6,467-$18,688) in the two years after recovery.
CONCLUSION
Surgery for chronic ulcerative colitis resulted in reduced direct costs in the two years after surgical recovery. These observations suggest that surgical intervention for ulcerative colitis is associated with long-term economic benefit.
目的
本研究旨在检验以下假设，即与术前相比，接受慢性溃疡性结肠炎确定性手术的患者在全结肠直肠切除术后直接医疗费用降低。
方法
使用罗切斯特流行病学项目，从 1988 年至 2007 年确定接受结肠直肠切除术治疗溃疡性结肠炎的患者的基于人群的队列。从管理数据库中估算总直接医疗保健费用。主要结果是手术前两年和手术后恢复期（手术+180 天）的观察到的成本差异。使用配对 t 检验和自举方法评估统计学意义。人口统计学数据以中位数（四分位距）或频率（比例）表示。2007 年以不变美元报告平均费用。
结果
60 名患者在手术时和整个观察期间均为明尼苏达州罗切斯特县居民。共有 40 名患者（66%）为男性，中位年龄为 42（范围，31-52）岁，中位结肠炎病程为 4（范围，1-11）年。手术包括回肠袋肛门吻合术（n=45，手术/恢复期的平均费用为 50530 美元）和全结肠直肠切除伴布鲁克造口术（n=15，手术/恢复期的平均费用为 39309 美元）。在回肠袋亚组中，恢复后两年内平均直接医疗费用减少了 9296 美元（P<0.001，自举 95%置信区间：324-15628）。在布鲁克造口术亚组中，恢复后两年内平均直接医疗费用减少了 12529 美元（P<0.001，自举 95%置信区间：6467-18688）。
结论
溃疡性结肠炎的手术导致术后恢复两年内直接费用降低。这些观察结果表明，溃疡性结肠炎的手术干预与长期经济效益相关。
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