Jones Claire, Mawhinney Abi, Brown Robin
Department of General Surgery, Daisy Hill Hospital Newry, BT35 8DR.
Ulster Med J. 2012 Jan;81(1):10-3.
Gallstone related disease accounts for a large expenditure in the NHS. The aim of this study was to review the events and costs of the patient journey to treatment, and propose guidelines to provide an efficient streamlined service.
All cholecystectomies performed in one unit in 2009 were reviewed. The cost of all investigations and procedures performed was obtained from the Department of Health website. The individual cost was calculated for each patient. Results were expressed as mean (±SD) and compared using ANOVA.
132 patients (31 male) were reviewed with an overall age was 45.3 years (±15.1). Overall cost from referral to discharge was £4697 (±2007) per patient, ranging from £3406 to £12011. The largest proportion was contributed by surgery at £2849 (±414), followed by inpatient costs at £1527 (±1322). Pre-operative outpatient consultations were £174 (±144), supplemented by at least one ultrasound (£81±29). Additional imaging was required for only a minority. All blood tests involved in overall care contributed little to the total at £27 (±26). Patients who initially presented as an inpatient had an overall larger cost (£6112±1888 vs. £5097±1607; p=0.004). This difference was largely due to inpatient costs (£2611±1629 vs. £1194±1009; p<0.0001) and not the cost of surgery (p=0.29). Patients who were imaged in primary care prior to referral also had a lower overall cost (£4636±1343 vs. £5697±1804; p=0.0005). This was also due to inpatient costs (£1076±876 vs. £1740±1459; p=0.004) and not the actual surgery costs (p=0.36). Only 39 were reviewed post-operatively, adding £38±69 to the overall cohort costs.
Emergency presentation and repeat admissions result in higher inpatient costs and should be avoided. Reduced delay to elective surgery through active participation by primary care needs to be encouraged.
与胆结石相关的疾病在英国国家医疗服务体系（NHS）中占据了大量支出。本研究的目的是回顾患者接受治疗过程中的各项事件及费用，并提出指导方针以提供高效简化的服务。
对2009年在一个科室进行的所有胆囊切除术进行了回顾。所有检查和手术的费用从卫生部网站获取。计算了每位患者的个人费用。结果以均值（±标准差）表示，并使用方差分析进行比较。
共对132例患者（31例男性）进行了回顾，总体年龄为45.3岁（±15.1）。从转诊到出院的每位患者总费用为4697英镑（±2007），范围从3406英镑到12011英镑。最大的费用部分是手术费用，为2849英镑（±414），其次是住院费用，为1527英镑（±1322）。术前门诊会诊费用为174英镑（±144），至少还需一次超声检查费用（81±29英镑）。只有少数患者需要额外的影像学检查。总体护理中涉及的所有血液检查费用在总费用中占比很小，为27英镑（±26）。最初以住院患者身份就诊的患者总体费用更高（6112±1888英镑对5097±1607英镑；p = 0.004）。这种差异主要是由于住院费用（2611±1629英镑对1194±1009英镑；p < 0.0001），而非手术费用（p = 0.29）。在转诊前在基层医疗机构进行过影像学检查的患者总体费用也较低（4636±1343英镑对5697±1804英镑；p = 0.0005）。这同样是由于住院费用（1076±876英镑对1740±1459英镑；p = 0.004），而非实际手术费用（p = 0.36）。术后仅对39例患者进行了回顾，使总体队列费用增加了38±69英镑。
急诊就诊和再次入院会导致更高的住院费用，应予以避免。需要鼓励基层医疗积极参与，以减少择期手术的延迟。
