Sivakumar Jonathan, Alnimri Feras, Johnson Mary A, Ward Salena, Chong Lynn, Hii Michael W
Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Jan;91(1-2):E1-E6. doi: 10.1111/ans.16014. Epub 2020 Jun 2.
The management of post-gastrectomy complications requires considerable resources and is likely associated with a substantial economic burden. The objectives of this study were to perform a cost analysis of admissions following gastrectomy for gastric carcinoma and then to quantify the financial impact of post-operative complications.
A retrospective analysis was conducted in patients that underwent a gastrectomy from 2008 to 2019. Demographic data, operative information, post-operative complications and facility costs were compared.
A total of 74 patients underwent a curative-intent gastrectomy during the study period. The 36 (48.6%) patients that had no complications had a median total admission cost of AU$29 228. A total of 21 (28.4%) patients had a minor complication and 17 (23.0%) patients had a major complication, with a median total admission cost of AU$36 592 and AU$71 808, respectively. The difference across all three groups was statistically significant. In patients who had major complications compared to those without complications, there was a significant increase in the cost of intensive care services, theatre resources and nursing care. Across the whole cohort, the principal cost centres accounting for the largest proportion of total cost were theatre equipment and resources (33.9%), nursing care on the ward (23.0%) and staffing time of the surgical team (16.7%).
The surgical management of gastric cancer carries a substantial cost burden. The presence and severity of post-operative complications is strongly associated with increasing cost. Minimizing complications, in addition to obvious clinical benefits, enables a large reduction in costs of care.
胃癌切除术后并发症的管理需要大量资源，且可能带来巨大的经济负担。本研究的目的是对胃癌胃切除术后的住院费用进行成本分析，然后量化术后并发症的经济影响。
对2008年至2019年接受胃切除术的患者进行回顾性分析。比较了人口统计学数据、手术信息、术后并发症和设施成本。
在研究期间，共有74例患者接受了根治性胃切除术。36例（48.6%）无并发症的患者的住院总费用中位数为29228澳元。共有21例（28.4%）患者发生轻微并发症，17例（23.0%）患者发生严重并发症，住院总费用中位数分别为36592澳元和71808澳元。三组之间的差异具有统计学意义。与无并发症的患者相比，发生严重并发症的患者在重症监护服务、手术室资源和护理方面的费用显著增加。在整个队列中，占总成本比例最大的主要成本中心是手术室设备和资源（33.9%）、病房护理（23.0%）和手术团队的人员时间（16.7%）。
胃癌的手术治疗带来了巨大的成本负担。术后并发症的存在和严重程度与成本增加密切相关。除了明显的临床益处外，减少并发症还能大幅降低护理成本。
