Wang Edward, Jootun Ravish, Foster Amanda
Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2018 Dec;88(12):1284-1288. doi: 10.1111/ans.14727. Epub 2018 Jul 11.
The acute surgical unit (ASU) model of acute general surgery care offers efficient patient assessment, improved clinical outcomes and has been demonstrated to be cost-efficient. Despite this, the management of acute appendicitis in our ASU was found to be highly cost-negative. This study sought to identify the drivers of increased cost.
A retrospective cost analysis of all patients with uncomplicated acute appendicitis in 2016 was undertaken to investigate the drivers of increased cost. The patient-level costing approach was used to assign cost to patients.
The ASU management of uncomplicated appendicitis was found to have made a net loss of $625 000 in 2016. This study identified that the three largest cost drivers in appendicitis care were hospital overheads, bed day length of admission cost and operating theatre costs. Radiology, pathology and pharmacy costs did not affect total cost significantly.
Two key targets for improvement were identified. First, reduced theatre turnaround times will allow more efficient theatre utilization. Second, improved after-hours and weekend theatre availability will reduce preoperative waiting time-related cost.
急性普通外科护理的急性手术单元（ASU）模式能实现高效的患者评估，改善临床结局，且已被证明具有成本效益。尽管如此，我们ASU中急性阑尾炎的管理却被发现成本效益极低。本研究旨在确定成本增加的驱动因素。
对2016年所有单纯性急性阑尾炎患者进行回顾性成本分析，以调查成本增加的驱动因素。采用患者层面的成本核算方法为患者分配成本。
2016年ASU对单纯性阑尾炎的管理出现了62.5万美元的净亏损。本研究确定，阑尾炎护理中三个最大的成本驱动因素是医院间接费用、住院日床位成本和手术室成本。放射科、病理科和药房成本对总成本没有显著影响。
确定了两个关键的改进目标。第一，缩短手术室周转时间将提高手术室利用效率。第二，改善非工作时间和周末的手术室可用性将降低与术前等待时间相关的成本。
