單切口與多切口腹腔鏡疝氣修補手術成本效果分析之比較-以南部某醫學中心為例

Cost effectiveness analysis of single-incision versus multi-incision laparoscopic hernioplasty：Example of a medical center in southern Taiwan

葉淑菁(Shu-Cing Yeh)

指導教授 ： 張永源

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2020年)

摘要

研究目的
隨著微創外科手術不斷發展，腹腔鏡疝氣修補術已經有單切口腹腔鏡疝氣修補手術與多切口腹腔鏡疝氣修補手術。單切口腹腔鏡耗材目前尚未納入健保給付，現今也少有單切口腹腔鏡疝氣修補手術與多切口腹腔鏡疝氣修補手術成本效果分析的相關文獻。因此本研究目的為進行單切口腹腔鏡疝氣修補手術與多切口腹腔鏡疝氣修補手術成本效果分析之比較。
研究方法
本研究為回溯性研究次級資料分析法，以台灣南部某醫學中心2016年1月至2019年12月期間，進行腹腔鏡疝氣修補術75610B並排除同時進行其他手術的病人為研究樣本，依其疝氣發生的側性分為單側疝氣與雙側疝氣，再依照手術方式分為單切口與多切口，收集其住院批價資料檔、住院申報資料檔及門診申報資料檔進行分析。為避免偏差，單側單切口腹腔鏡疝氣修補術24例、單側多切口腹腔鏡疝氣修補術222例，透過複線性迴歸分析；而雙側腹腔鏡疝氣修補術將單切口與多切口腹腔鏡手術兩組病人利用判別分析進行傾向分數1：3配對後，雙側單切口腹腔鏡疝氣修補術64例、雙側多切口腹腔鏡疝氣修補術192例納入研究樣本。採用統計套裝軟體SPSS中文20版將資料處理後，進行成本效果分析。
研究結果
單切口腹腔鏡疝氣修補術手術費用顯著高於多切口腹腔鏡疝氣修補術（單側單切口組多21,657.11元、雙側單切口組多14,211.19元，p<.0005），單切口腹腔鏡疝氣修補術手術當次住院費用均顯著高於多切口腹腔鏡疝氣修補術（單側單切口組多46,388.368元、雙側單切口組多20,584.62元，p<.0005），但術後門診追蹤費用則無顯著差異。而效果分析，單切口腹腔鏡疝氣修補術組手術時間均顯著少於多切口腹腔鏡疝氣修補術組（單側單切口組少20.706分鐘，p＝.013；雙側單切口組少16.54分鐘，p＝.001）；住院天數與術後門診次數方面，單切口腹腔鏡疝氣修補術組都比多切口腹腔鏡疝氣修補術組少，但未達到統計學上的顯著差異。多切口腹腔鏡疝氣修補術成本上較佔優勢，但在手術時間、住院天數與術後門診追蹤次數，單切口腹腔鏡疝氣修補術，效果表現較佳。
結論與建議
單切口腹腔鏡疝氣修補術，在手術時間、住院天數與術後門診追蹤次數等效果較佳，但多切口腹腔鏡疝氣修補術成本上較佔優勢，因此以遞增成本效果分析來看，單切口腹腔鏡疝氣修補術並未有較好的成本效果。不過本研究僅為單一醫學中心為研究樣本且收案時間較短不足以概括全體，建議未來能納入疝氣復發率、單切口腹腔鏡術後切口疝氣發生機率、術後疼痛情形與多久可返回工作崗位等等研究，將會使整個研究分析更加完善。

關鍵字

疝氣修補術 ； 單切口腹腔鏡 ； 多切口腹腔鏡 ； 成本效果分析

並列摘要

Objective
With the advance development of minimally invasive surgery, laparoscopic hernioplasty is divided into single-incision versus multi-incision laparoscopic hernioplasty. The National Health Insurance is not payed for single-incision laparoscopic consumables. There are relatively few literatures on the cost-effectiveness analysis of single-incision and multi-incision laparoscopic hernioplasty. Therefore, the study aimed to compare the cost and effectiveness of single-incision versus multi-incision laparoscopic hernioplasty.
Methods
This is a retrospective study, using secondary data analysis. The study sample were patient obtained from a medical center in southern Taiwan between January 2016 and December 2019, who received laparoscopic hernioplasty and exclude other operations at the same time. The occurrence of inguinal hernia is divided into unilateral and bilateral. The occurrence of inguinal hernia is divided into unilateral and bilateral, and then divided into single-incision and multi-incision laparoscopic hernioplasty according to the surgical method. Collect and analyze the hospitalization data files, hospitalization declaration data files and outpatient declaration data files.
In patients with unilateral hernia, 24 patients received single incision laparoscopic hernioplasty, and 222 patients received multiple incision laparoscopic hernioplasty. Use multiple linear regression for analysis.
In patients with bilateral hernias were paired using a discriminant analysis method of 1: 3, 64 patients received single-incision laparoscopic hernioplasty, and 192 patients received multi-incision laparoscopic hernioplasty. This study uses statistical software SPSS version 20 for cost-effectiveness analysis.
Results
The cost of single-incision laparoscopic hernioplasty and hospitalization are significantly higher than those of multi-incision laparoscopic hernioplasty (p <.0005). There was no significant difference in outpatient follow-up costs after surgery. The operation time of single-incision laparoscopic hernioplasty was significantly shorter than that of the multi-incision laparoscopic hernioplasty group (unilateral: p = .013, bilateral: p = .001). The single-incision laparoscopic hernioplasty group was less than the multi-incision laparoscopic hernioplasty group in terms of hospitalization days and postoperative outpatient follow-up times, but did not reach statistically significant differences.
Multi-incision laparoscopic hernioplasty has advantages in cost. Single-incision laparoscopic hernioplasty performed better in terms of time of operation, days of hospitalization, and follow-up visits after surgery.
Conclusion and Suggestion
Single-incision laparoscopic hernioplasty performed better in terms of time of operation, days of hospitalization, and follow-up visits after surgery. But, multi-incision laparoscopic hernioplasty has advantages in cost. Therefore, in terms of incremental cost-effectiveness analysis, single-incision laparoscopic hernia repair does not have a good cost-effectiveness.
However, this study is only a single medical center as the research sample and the short time to receive the case is not enough to summarize the whole. It is recommended that studies including the recurrence rate of hernias, the incidence of incisional hernias after single incision laparoscopic surgery, the postoperative pain situation and how long to return to work will be included in the future, which will make the entire study analysis more complete.

並列關鍵字

hernioplasty ； Single-incision laparoscopic ； multi-incision laparoscopic ； cost-effectiveness analysis

參考文獻

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