Chong Vincent, Zhou Lifeng, Hundal Hardeep, Koea Jonathan
The Department of Surgery, North Shore Hospital, Private Bag 93503, Takapuna, Auckland, New Zealand.
N Z Med J. 2014 Aug 1;127(1399):51-7.
Treatment of cutaneous abscesses is an important part of the acute surgical workload and most are treated with incision and drainage. Traditionally most are treated after major cases in theatre prioritisation and remain in hospital overnight.
To examine the cost saved in patients after drainage of skin abscesses according to the time of surgery ('am' versus 'pm').
The clinical records of all patients who underwent acute incision and drainage of cutaneous abscesses at North Shore Hospital (Takapuna, Auckland, New Zealand) between 1 June-31 December 2011 were reviewed with respect to the time of day when surgery was performed [am (defined as 0730-12 noon of the day of surgery)] versus pm). Costs were calculated using standard tariffs set by our hospital.
339 patients (median age 34 yr, 164 female) were admitted for acute drainage of cutaneous abscesses with 149 operated in "am". There was no difference in patients undergoing am versus pm drainage in terms of age, sex, race, Charlson comorbidity score or smoking status although diabetic patients were more likely to undergo a pm drainage (p=0.008). The median cost per discharge was NZ$2397.39. The cost of the 'am' group was significantly less compared to the cost of the 'pm' group with NZ$2236.63 compared to NZ$2531.70 (p=0.0034) and saved a median of NZ$295.07 per patient. This amounted to the cost of an overnight bed stay.
Prioritisation of abscess drainage in acute theatre management is safe and associated with significant cost savings.
皮肤脓肿的治疗是急性外科工作量的重要组成部分，大多数通过切开引流进行治疗。传统上，大多数在手术室优先处理重大病例之后进行治疗，并需住院过夜。
根据手术时间（“上午”与“下午”）检查皮肤脓肿引流术后患者节省的费用。
回顾了2011年6月1日至12月31日期间在北岸医院（新西兰奥克兰塔卡普纳）接受皮肤脓肿急性切开引流的所有患者的临床记录，比较手术时间为上午（定义为手术当天07:30至中午12点）与下午的情况。费用使用我院设定的标准收费标准计算。
339例患者（中位年龄34岁，女性164例）因皮肤脓肿急性引流入院，其中149例在上午进行手术。上午与下午引流的患者在年龄、性别、种族、查尔森合并症评分或吸烟状况方面无差异，尽管糖尿病患者更有可能在下午进行引流（p = 0.008）。每次出院的中位费用为2397.39新西兰元。“上午”组的费用明显低于“下午”组，分别为2236.63新西兰元和2531.70新西兰元（p = 0.0034），每位患者平均节省295.07新西兰元。这相当于一晚住院床位的费用。
在急性手术室管理中优先进行脓肿引流是安全的，且能显著节省费用。
