治疗穿孔性消化性溃疡疾病的成本效益和结果：腹腔镜与开放手术。

Cost-efficiency and outcomes in the treatment of perforated peptic ulcer disease: laparoscopic versus open approach.

机构信息

General Surgery Residency Program, Grand Rapids Medical Education Partners, Grand Rapids, MI; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI.

Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI; Research Department, Grand Rapids Medical Education Partners, Grand Rapids, MI.

出版信息

Surgery. 2014 Oct;156(4):1003-7. doi: 10.1016/j.surg.2014.06.047.

DOI:10.1016/j.surg.2014.06.047

PMID:25239359

Abstract

PURPOSE

Laparoscopic treatment of perforated peptic ulcer disease (perfPUD) has demonstrated comparable operative outcomes with an open approach though the cost-efficiency of this method has not been studied.

METHODS

Data were obtained from the Nationwide Inpatient Sample (2007-2010). Patients who underwent operation for perfPUD were divided on the basis of laparoscopic or open approach. The primary outcome measures were hospital duration of stay, mortality, and total charges.

RESULTS

A total of 5,361 patients with perfPUD were identified: 5,219 in the open group and 142 in the laparoscopic group. Patients in the laparoscopic group were younger (50.5 vs 60.0, P < .001) and had a lesser incidence at presentation of sepsis (8.5 vs 14.8%, P = .034) and shock (2.1 vs 7.7%, P = .012). On univariate analysis, the laparoscopic group had decreased duration of stay (7.0 vs 8.0 days, P < .001), lesser rates of mortality (3.5 vs 8.1%, P = .048), and were discharged to home more frequently (79.6 vs 68.1%, P = .025). Mean total charges were less in the laparoscopic group ($44,095 vs $52,055, P = .019). Multivariate analyses failed to show a difference between groups for any of the outcome variables.

CONCLUSION

The laparoscopic treatment of perfPUD is associated with equivalent costs and outcomes compared with the open technique when we corrected for presentation variables.

摘要

目的

腹腔镜治疗穿孔性消化性溃疡疾病（perfPUD）的手术效果与开放性手术相当，但尚未研究该方法的成本效益。

方法

从全国住院患者样本（2007-2010 年）中获取数据。根据腹腔镜或开放性方法将接受 perfPUD 手术的患者进行分组。主要观察指标为住院时间、死亡率和总费用。

结果

共确定了 5361 例 perfPUD 患者：开放性组 5219 例，腹腔镜组 142 例。腹腔镜组患者年龄较小（50.5 岁 vs 60.0 岁，P <.001），就诊时脓毒症（8.5% vs 14.8%，P =.034）和休克（2.1% vs 7.7%，P =.012）的发生率较低。单因素分析显示，腹腔镜组的住院时间较短（7.0 天 vs 8.0 天，P <.001），死亡率较低（3.5% vs 8.1%，P =.048），出院回家的比例较高（79.6% vs 68.1%，P =.025）。腹腔镜组的总费用均值较低（$44095 美元 vs $52055 美元，P =.019）。多因素分析显示，在调整了表现变量后，两组之间任何结果变量均无差异。