Mortuaire G, Theis D, Fackeure R, Chevalier D, Gengler I
Service d'ORL de chirurgie cervico-faciale, hôpital Huriez, CHRU de Lille, 59000 Lille, France; Inserm U995, Lille Inflammation Research International Center, université de Lille, Lille, France.
Département d'information médicale, université de Lille, Lille, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Feb;135(1):11-15. doi: 10.1016/j.anorl.2017.08.004. Epub 2017 Sep 18.
To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses.
A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue.
Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two.
This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care.
从临床疗效和费用控制方面评估门诊鼻窦手术的成本效益。
进行一项回顾性研究，时间跨度为2014年1月至2016年1月。系统纳入计划接受门诊鼻窦手术的患者。临床数据从外科和麻醉学计算机文件中提取。使用本机构应用的成本核算方法评估后勤和技术成本。基于住院时间和诊断相关组（住院同质性分组：GHS）严重程度的标准化医院收费评级系统用于估计机构收入。
在2年多的时间里，共进行了927例门诊手术。转为传统住院治疗的比例为2.9%。在术后第1天的电话随访中，85%的患者对手术非常满意。所有门诊病例的费用均显著低于预计的传统过夜住院治疗费用，而两者的医院收入无差异。
本研究证实了门诊手术在该适应症中的疗效。降低成本可通过调整手术评级为卫生系统节省开支。更精确的成本效益评估将需要基于医院层面微观成本核算的更细致研究，以及对传统手术活动和出院后社区护理影响的评估。
