Kim Hongbeom, Chung Jung Kee, Ahn Young Joon, Lee Hae Won, Jung In Mok
Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2017 Feb;92(2):73-81. doi: 10.4174/astr.2017.92.2.73. Epub 2017 Jan 31.
Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD.
From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status.
The percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6-137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%.
Performing PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness.
胰十二指肠切除术（PD）是一项复杂的手术，具有较高的发病率、死亡率和成本。市级医院在公共卫生和福利体系中发挥着重要作用。本研究的目的是基于13年的PD经验，确定在中等规模市级医院进行PD的可行性和成本效益。
2003年3月至2015年11月，183例患者在首尔市政府 - 首尔国立大学博拉梅医疗中心接受了PD手术。对回顾性收集的数据进行分析，特别关注并发症。分析医院成本并与国家数据库进行比较，根据医疗保险状况将患者分为两组。
医疗救助的比例显著高于韩国医院的平均水平。（19.1%对5.8%，P = 0.002）。88例患者（44.3%）发生并发症。术后胰瘘（POPF）发生113例（61.7%），但临床相关的POPF为24.6%（B级：23.5%，C级：1.1%）。术后中位住院时间为20天（范围6 - 137天）。住院死亡率为3.8%（n = 7），肺部并发症是主要原因。在研究期间，观察到POPF发生率、手术时间和住院时间有所改善。每位患者的平均总住院费用为13,819美元，国家健康保险服务（NHIS）向医疗服务提供者的平均报销金额为10,341美元（74.8%）。NHIS支付中患者自付部分为5%。
在中等规模市级医院进行PD是可行的，结果和成本效益相当。
