腹腔镜胆囊切除术后持续腹痛与增加的医疗保健消费和病假有关。

Persistent abdominal pain after laparoscopic cholecystectomy is associated with increased healthcare consumption and sick leave.

机构信息

Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.

出版信息

Surgery. 2018 Apr;163(4):661-666. doi: 10.1016/j.surg.2017.09.004. Epub 2017 Nov 10.

DOI:10.1016/j.surg.2017.09.004

PMID:29133112

Abstract

BACKGROUND

Although, 33% to 40% of symptomatic gallstone patients reported persistent abdominal pain after laparoscopic cholecystectomy, there is no data on the burden of this pain to the healthcare system and society at large. This study determined healthcare consumption, sick leave, and costs in patients with persistent abdominal pain after laparoscopic cholecystectomy. Secondly, predictive factors for healthcare consumption were assessed.

METHODS

This cross-sectional study included all 146 patients with persistent abdominal pain (patient-reported on Gastro-Intestinal Quality of Life Index (score 0-3) 24 weeks after laparoscopic cholecystectomy, derived from a previous prospective cohort. Healthcare consumption was assessed using Medical Consumption Questionnaire and medical records, and sick leave using Productivity Cost Questionnaire. Costs were calculated according "Guideline for performing economic evaluations in healthcare." Predictors of healthcare consumption were assessed using logistic regression analysis.

RESULTS

In the study, 124/146 patients (85%) responded after mean follow-up of 31.0 months (standard deviation 6.5); 104 were female, mean age of responders was 52 years. Sixty-nine patients needed additional healthcare; 30.6% primary care; 37.1% secondary care; 16% emergency department admission; 8.9% hospital admission; 33.9% diagnostic procedures; 17.7% medication; 5.6% other interventions. Medical costs were $555 (BCa 95% confidence interval, $329-$852) and costs of sick leave were $361 (Bias-corrected and accelerated (BCa) 95% confidence interval, $189-$566) per year per patient. Younger age (odds ratio 0.95, 95% confidence interval, 0.92-0.98) and higher postoperative pain score (odds ratio 1.02, 95% confidence interval, 1.01-1.04) were associated with increased healthcare consumption.

CONCLUSION

Persistent abdominal pain after laparoscopic cholecystectomy is associated with additional healthcare in 56% of patients. Yearly, medical costs and costs of sick leave are 20% of the initial costs of laparoscopic cholecystectomy.

摘要

背景

尽管有 33%至 40%的有症状胆石症患者在腹腔镜胆囊切除术后仍持续存在腹痛，但尚无关于此类疼痛给医疗保健系统和整个社会带来的负担的数据。本研究旨在确定腹腔镜胆囊切除术后持续性腹痛患者的医疗保健消费、病假和成本。其次，评估了医疗保健消费的预测因素。

方法

本横断面研究纳入了 146 例腹腔镜胆囊切除术后持续性腹痛患者（患者在腹腔镜胆囊切除术后 24 周使用胃肠道生活质量指数（评分 0-3）报告，该数据来自先前的前瞻性队列研究）。使用医疗消费问卷和医疗记录评估医疗保健消费，使用生产效率成本问卷评估病假。根据“医疗保健中进行经济评估的指南”计算成本。使用逻辑回归分析评估医疗保健消费的预测因素。

结果

在这项研究中，在平均 31.0 个月（标准差 6.5）的随访后，146 例患者中有 124 例（85%）做出了回应；104 例为女性，应答者的平均年龄为 52 岁。69 例患者需要额外的医疗保健；30.6%为初级保健；37.1%为二级保健；16%为急诊就诊；8.9%为住院治疗；33.9%为诊断程序；17.7%为药物治疗；5.6%为其他干预措施。每位患者每年的医疗费用为 555 美元（BCa 95%置信区间为 329-852 美元），病假费用为 361 美元（经校正和加速（BCa）95%置信区间为 189-566 美元）。年龄较小（比值比 0.95，95%置信区间为 0.92-0.98）和术后疼痛评分较高（比值比 1.02，95%置信区间为 1.01-1.04）与医疗保健消费增加相关。