摘要
目的 分析腹腔镜下胆囊切除术住院费用的影响因素,为费用管控提供参考依据.方法 从四川省DRGs应用平台数据中收集2022年1月1日-2023年6月30日纳入腹腔镜下胆囊切除术不伴胆总管探查组的病例2603例为研究对象,利用非参数检验和卡方检验比较正常组和高费用组影响因素的差异,运用结构方程验证各影响因素与住院费用的相关性.结果 正常组和高费用组在年龄、入院情况、住院次数、住院天数、其他诊断数量、其他手术操作数量、转科情况、是否病危或病重、有无会诊、是否使用抗菌药物、是否伴有合并症和并发症方面均有统计学差异(P＜0.05).结构方程模型结果显示,影响效应从大到小依次为其他手术操作数量(0.50),住院天数(0.31)、其他诊断数量(0.24)、是否伴合并症和并发症(0.14)、是否使用抗菌药物(0.12)、有无会诊(0.10)、是否病危或病重(0.07)、入院情况(0.07)、年龄(0.05)、转科情况(0.03)和住院次数(0.01).结论 对住院费用影响因素最大的是其他手术操作数量,其次为住院天数.应加强对诊断费、药品费和耗材费等的监管,规范诊疗行为,缩短住院天数,有效降低腹腔镜下胆囊切除术患者住院总费用.
Abstract
Objectives To analyze the influencing factors of hospitalization costs for laparoscopic cholecystectomy after DRG grouping,and provide reference for costs control.Method A study was conducted on 2603 patients who underwent laparoscopic cholecystectomy at a tertiary comprehensive hospital in Sichuan Province from January 1st,2022 to June 30th,2023.Non parametric tests and Chi-square tests were used to compare the differences in influencing factors between the normal group and the high costs group,and structural equations were used to verify the correlation between each influencing factor and hospitalization costs.Results There were statistical differences(P＜0.05)between the normal group and the high costs group in terms of age,admission status,number of hospitalizations,length of stay,number of other diagnoses,number of other surgical procedures,transfer status,whether the patient was critically ill or seriously ill,whether consultation was conducted,whether antibiotics were used,and whether there were comorbidities and complications.The results of the structural equation model showed that the influencing factors ranked from large to small were the number of other surgical procedures(0.50),length of hospital stay(0.31),number of other diagnoses(0.24),presence of comorbidities and complications(0.14),use of antibiotics(0.12),presence or absence of consultations(0.10),critical or severe illness(0.07),admission status(0.07),age(0.05),transfer status(0.03),and number of hospitalizations(0.01).Conclusions The most significant factor affecting hospitalization costs was the number of other surgical procedures,followed by the length of hospital stay.We should strengthen the supervision of diagnostic fees,drug costs,and consumables costs,standardize diagnosis and treatment behaviors,shorten hospitalization days,and effectively reduce the total hospitalization costs of patients undergoing laparoscopic cholecystectomy.
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