de la Hunt M N, Chan A Y, Karran S J
Ann R Coll Surg Engl. 1986 Jul;68(4):199-202.
Complications following major abdominal surgery incur considerable expense. The aims of this study were to analyse prospectively the costs of complications following major abdominal surgery and to compare such costs with those of elective distal large bowel resection. Six patients undergoing elective resection for large bowel cancer were studied at the Royal South Hants Hospital between January and March 1983. The mean cost of resection and primary anastomosis, without postoperative complications, was pounds 1,364 (n = 4). Indirect costs accounted for 38%, nursing 25%, medical staff 13%, investigations 8% and consumables 16%. The operation itself accounted for 12% of the total. Complications following major abdominal surgery were studied in a further ten patients. The costs of complications not prolonging hospital stay were: wound infection pounds 64-146; chest infection pounds 21-27; urinary infection pounds 3-6. Complications prolonging hospital stay resulted in considerably greater cost: pelvic abscess pounds 1245; myocardial infarction pounds 476; subphrenic abscess pounds 857; colostomy retraction pounds 764; wound dehiscence pounds 599; incisional hernia pounds 1723, and major chest infection pounds 258. Owing to high fixed costs, the main factor in determining cost for bowel resection and complications was length of hospital stay.
腹部大手术后的并发症会产生相当高的费用。本研究的目的是前瞻性分析腹部大手术后并发症的费用，并将这些费用与选择性远端大肠切除术的费用进行比较。1983年1月至3月期间，在皇家南汉普郡医院对6例接受择期大肠癌切除术的患者进行了研究。无术后并发症的切除及一期吻合术的平均费用为1364英镑（n = 4）。间接费用占38%，护理占25%，医务人员占13%，检查占8%，耗材占16%。手术本身占总费用的12%。在另外10例患者中研究了腹部大手术后的并发症。未延长住院时间的并发症费用为：伤口感染64 - 146英镑；肺部感染21 - 27英镑；泌尿系统感染3 - 6英镑。延长住院时间的并发症导致的费用要高得多：盆腔脓肿1245英镑；心肌梗死476英镑；膈下脓肿857英镑；结肠造口回缩764英镑；伤口裂开599英镑；切口疝1723英镑，以及严重肺部感染258英镑。由于固定成本较高，决定大肠切除术及并发症费用的主要因素是住院时间。
