Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea.
Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea.
Yonsei Med J. 2023 Mar;64(3):213-220. doi: 10.3349/ymj.2022.0546.
The purpose of this study was to compare patients who had undergone spine surgery (SS) and hip arthroplasty surgery (HAS) and to analyze how medical policies drawn from "The Evaluation of the Appropriate Use of Prophylactic Antibiotics" have affected length of hospital stay (LOS), direct medical costs (DMC), and the duration of antibiotics use in Korea.
This retrospective nationwide study identified subjects from the Korean National Health Insurance Review and Assessment Service database from January, 2011 to December, 2018. Evaluation of HAS (control group) was implemented in 2007, and that for SS (case group) was conducted for the first time in 2014 (intervention time). In our comparative interrupted time series analysis, we compared DMC, LOS, and use of antibiotics between both groups.
177468 patients who underwent SS and 89372 patients who underwent HAS were included in the study. In 2016, DMC increased for HAS, compared to SS, by 1.03 times (=0.041). However, cost changes during other observational periods for SS were not higher than those for HAS (>0.05). SS incurred a reduced LOS of 3% in the first 2 years (<0.05). Thereafter, LOS changes in SS were not smaller than those in HAS. A decrease in the usage of total antibiotics and broad spectrum antibiotics was observed for 5 years.
This medical policy was effective in terms of reducing usage and duration of antibiotics use, especially in the first 2 years after the implementation of the policy.
本研究旨在比较接受脊柱手术（SS）和髋关节置换手术（HAS）的患者，并分析《预防性抗生素合理使用评估》中的医疗政策如何影响韩国的住院时间（LOS）、直接医疗费用（DMC）和抗生素使用时间。
本回顾性全国性研究从 2011 年 1 月至 2018 年 12 月期间，从韩国国家健康保险审查和评估服务数据库中确定了研究对象。HAS（对照组）的评估于 2007 年进行，而 SS（病例组）的评估则于 2014 年首次进行（干预时间）。在我们的比较中断时间序列分析中，我们比较了两组之间的 DMC、LOS 和抗生素使用情况。
本研究纳入了 177468 例接受 SS 手术的患者和 89372 例接受 HAS 手术的患者。与 SS 相比，2016 年 HAS 的 DMC 增加了 1.03 倍（=0.041）。然而，在 SS 的其他观察期内，成本变化并未高于 HAS（>0.05）。在最初的 2 年内，SS 的 LOS 减少了 3%（<0.05）。此后，SS 的 LOS 变化并不小于 HAS。5 年内，总抗生素和广谱抗生素的使用量呈下降趋势。
该医疗政策在减少抗生素的使用量和使用时间方面是有效的，特别是在政策实施后的头 2 年。
