Eaton A C, Marsh J L, Pilgram T K
Department of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Plast Reconstr Surg. 1994 Dec;94(7):911-5; discussion 916-8.
Insurance carriers affected decisions regarding admissions and length of stay in our hospital in 1987. Charts were reviewed retrospectively to determine whether this affected morbidity and mortality rates following cleft lip and palate operations in infants. Two periods were studied: May of 1983 through April of 1987 (group I) and April of 1987 through May of 1991 (group II). A total of 248 infants with cleft lip and/or palate underwent 398 operations: lip adhesion (74), definitive lip repair (130), and palatoplasty (194). Half were performed in each period. Admission status, length of stay, length of operation, and short-term morbidity were documented. Morbidity included spontaneous and traumatic lip dehiscence, palatal dehiscence, and palatal fistula. Intergroup analysis was performed by the chi-squared method; p < or = 0.05 was statistically significant. In group I, 93 percent of patients were admitted before surgery. In group II, 5 percent were admitted before surgery and 79 percent the day of surgery. Hospital stay decreased nearly 2 days for each operation. There was no statistically significant difference between groups in distribution of operations, length of operations, or morbidity: lip surgery complications (p = 0.263), palatoplasty complications (p = 0.624). Reductions of hospital admissions and length of stay do not affect outcome of cleft lip and palate surgery in infants. The reduction in hospital days is equivalent to a savings of $138,000 (1991 dollars).
1987年，保险公司影响了我院关于入院及住院时长的决策。对病历进行回顾性审查，以确定这是否影响婴儿唇腭裂手术后的发病率和死亡率。研究了两个时期：1983年5月至1987年4月（第一组）和1987年4月至1991年5月（第二组）。共有248例唇裂和/或腭裂婴儿接受了398次手术：唇粘连（74例）、唇裂一期修复（130例）和腭裂修复术（194例）。每个时期各进行了一半手术。记录了入院状态、住院时长、手术时长和短期发病率。发病率包括自发性和外伤性唇裂、腭裂和腭瘘。采用卡方检验进行组间分析；p≤0.05具有统计学意义。在第一组中，93%的患者在手术前入院。在第二组中，5%的患者在手术前入院，79%的患者在手术当天入院。每次手术的住院时间减少了近2天。两组在手术分布、手术时长或发病率方面无统计学显著差异：唇裂手术并发症（p = 0.263），腭裂修复术并发症（p = 0.624）。减少住院入院人数和住院时长并不影响婴儿唇腭裂手术的结果。住院天数的减少相当于节省了13.8万美元（1991年美元）。
