Comparison of health economical evaluation between ambulatory surgery and special in-hospital surgery mode for flexible ureteroscopic holmium laser lithotriphy for ureteral calculi_West China Medical Journal

Authors：

PENG Jing , WANG Shuhong , MO Yang , XIAO Yingping ,  LIU Weidong

Day Surgery Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China;

Corresponding author：

LIU Weidong, Email: weidong.liu@csu.edu.cn

Keywords：

Day surgery; Ureteral calculi; Patients satisfaction; Cost; Cost-effectiveness; Health economical evaluation

DOI：

10.7507/1002-0179.201709206

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Objective To evaluate the ambulatory surgery mode by using health economical mothods and provide reference for optimization and decision of surgical operation mode. Methods The patients who underwent unilateral flexible ureteroscopic holmium laser lithotriphy for ureteral calculi in Xiangya Hospital, Central South University between January 1st to December 31th, 2015 were selected in this study, including 59 with ambulatory surgery mode (the ambulatory group) and 65 with special in-hospital surgery mode (the special group). The differences in average bed occupancy time, cost, therapeutic effect, and satisfaction between the two operation modes were compared. Results The average bed occupancy time in the ambulatory group and the special group was (1.03±0.18) and (6.35±0.74) days, respectively, and the difference was statistically significant (P<0.05). The patients in both groups were followed up for one month after the operation, and the incidence of complications was 6.8% (4/59) in the ambulatory group and 6.2% (4/65) in the special group, without significant difference (P>0.05). The satisfaction score in the ambulatory group and the special group was 96.48±0.23vs. 96.53±0.18 without significant difference (P>0.05). The differences in direct medical cost [(17 738.28±1 027.85)vs. (21 307.67±554.41) yuan], direct non-medical cost [(103.39±18.25) vs. (630.76±78.90) yuan], indirect cost[ (266.93±47.12) vs. (1 640.44±190.55) yuan], and total cost [(18 128.10±1 037.76) vs. (23 558.29±619.20) yuan] between the ambulatory group and the special group were all statistically significant (P<0.05). The treatment effect index in the ambulatory group and the special group was 0.96 and 1.05, respectively; the cost-effect ratio was 18 883.44 and 22 436.47, respectively. Sensitivity analysis showed that the adjusted cost-effect ratio in the ambulatory group (16 629.64) was still lower than that in the special group (20 534.91). Conclusions The cost-effect ratio of ambulatory surgery mode is superior than that of special in-hospital surgery mode, and there is no obvious difference in patients satisfaction between the two modes. Ambulatory surgery mode can be recommended to patients who meet the indications of day surgery.

Citation： PENG Jing, WANG Shuhong, MO Yang, XIAO Yingping, LIU Weidong. Comparison of health economical evaluation between ambulatory surgery and special in-hospital surgery mode for flexible ureteroscopic holmium laser lithotriphy for ureteral calculi. West China Medical Journal, 2017, 32(11): 1675-1679. doi: 10.7507/1002-0179.201709206 Copy

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3.	Sherigar JM, Irwin GW, Rathore MA, et al. Ambulatory laparoscopic cholecystectomy outcomes. JSLS, 2007, 10(4): 473-478.
4.	Teerawattananon Y, Mugford M. Is it worth offering a routine laparoscopic cholecystectomy in developing countries? A Thailand case study. Cost Eff Resour Alloc, 2005, 3(1): 10.
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6.	刘辉霞. 因工烧伤不同治疔方案的卫生经济学评价. 长沙: 中南大学, 2013.
7.	Ilia S, Frances C. Outcomes in day surgery. Curr Opin Anaesthesiol, 2006, 19(6): 622-629.
8.	Armanious S, Chung F. Quality management in ambulatory surgery. Prob Anesth, 2001, 13: 458-467.
9.	房良, 杨丽, 李国红, 等. 日间手术治疗模式的效果评价及影响因素分析. 中国医院, 2014(5): 34-35.
10.	王晓君. 胃癌术后序贯性早期肠内营养支持的临床效果及卫生经济学评价. 南京: 南京医科大学, 2014.
11.	刘蔚东. 日间手术合理调配诊疗资源. 中国卫生人才, 2016(3): 27-30.
12.	何琼, 张静, 周维强, 等. 湖南省某院日间手术实施现状分析. 中国病案, 2017, 18(2): 56-59.
13.	马洪升, 戴燕. 日间手术治疗模式国内外发展简述. 中国医院管理, 2012, 32(1): 47-48.
14.	张继东, 闻大翔, 范关荣. 日间手术对缩短平均住院日的影响. 中国医院管理, 2009, 29(11): 27-28.
15.	李关平, 罗艳霞, 雷静, 等. 腹腔镜胆囊切除术开展日间手术的可行性探讨. 现代预防医学, 2010, 37(23): 4576-4577.
16.	Ammori BJ, Davides D, Vezakis A, et al. Day-case laparoscopic cholecystectomy: a prospective evaluation of a 6-year experience. J Hepatobiliary Pancreat Surg, 2003, 10(4): 303-308.
17.	Keulemans Y, Eshuis J, de Haes H, et al. Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg, 1998, 228(6): 734-740.
18.	Ali A, Chawla T, Jamal A. Ambulatory laparoscopic cholecystectomy: is it safe and cost effective?. J Minim Access Surg, 2009, 5(5): 8-13.
19.	李良菊, 朱泉玉, 胡海燕. 经输尿管镜钬激光碎石日间手术的安全及质量评价. 海南医学, 2017, 28(1):141-143.

1. Reed WA. International Association for Ambulatory Surgery: ambulatory surgery: a worldwide concern. Ambulat Surg, 1995, 3(3): 155-160.
2. Agrawal S, Shapey I, Peacock A, et al. Prospective study of routine day-case laparoscopic modified lind partial fundoplication. World J Surg, 2009, 33(6): 1229-1234.
3. Sherigar JM, Irwin GW, Rathore MA, et al. Ambulatory laparoscopic cholecystectomy outcomes. JSLS, 2007, 10(4): 473-478.
4. Teerawattananon Y, Mugford M. Is it worth offering a routine laparoscopic cholecystectomy in developing countries? A Thailand case study. Cost Eff Resour Alloc, 2005, 3(1): 10.
5. Boothe P, Finegan BA. Changing the admission process for elective surgery: an economic analysis. Can J Anaesth, 1995, 42(5 Pt 1): 391-394.
6. 刘辉霞. 因工烧伤不同治疔方案的卫生经济学评价. 长沙: 中南大学, 2013.
7. Ilia S, Frances C. Outcomes in day surgery. Curr Opin Anaesthesiol, 2006, 19(6): 622-629.
8. Armanious S, Chung F. Quality management in ambulatory surgery. Prob Anesth, 2001, 13: 458-467.
9. 房良, 杨丽, 李国红, 等. 日间手术治疗模式的效果评价及影响因素分析. 中国医院, 2014(5): 34-35.
10. 王晓君. 胃癌术后序贯性早期肠内营养支持的临床效果及卫生经济学评价. 南京: 南京医科大学, 2014.
11. 刘蔚东. 日间手术合理调配诊疗资源. 中国卫生人才, 2016(3): 27-30.
12. 何琼, 张静, 周维强, 等. 湖南省某院日间手术实施现状分析. 中国病案, 2017, 18(2): 56-59.
13. 马洪升, 戴燕. 日间手术治疗模式国内外发展简述. 中国医院管理, 2012, 32(1): 47-48.
14. 张继东, 闻大翔, 范关荣. 日间手术对缩短平均住院日的影响. 中国医院管理, 2009, 29(11): 27-28.
15. 李关平, 罗艳霞, 雷静, 等. 腹腔镜胆囊切除术开展日间手术的可行性探讨. 现代预防医学, 2010, 37(23): 4576-4577.
16. Ammori BJ, Davides D, Vezakis A, et al. Day-case laparoscopic cholecystectomy: a prospective evaluation of a 6-year experience. J Hepatobiliary Pancreat Surg, 2003, 10(4): 303-308.
17. Keulemans Y, Eshuis J, de Haes H, et al. Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg, 1998, 228(6): 734-740.
18. Ali A, Chawla T, Jamal A. Ambulatory laparoscopic cholecystectomy: is it safe and cost effective?. J Minim Access Surg, 2009, 5(5): 8-13.
19. 李良菊, 朱泉玉, 胡海燕. 经输尿管镜钬激光碎石日间手术的安全及质量评价. 海南医学, 2017, 28(1):141-143.

West China Medical Journal

Comparison of health economical evaluation between ambulatory surgery and special in-hospital surgery mode for flexible ureteroscopic holmium laser lithotriphy for ureteral calculi

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