Cost and Outcome Analysis Between Conventional and Laparoscopic Splenectomy

• Main Authors: Tseng, Su-Mei, 曾素美
• Other Authors: Chang, Wen-Yin
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/93137947263251164098

碩士 === 臺北醫學大學 === 護理學研究所 === 93 === With the improvement in medical science and technology, minimal invasive or so call the smallest injury of the surgery, such as laparoscopic surgery has developed and accepted widely because this surgery for spleen excision can reduce blood loss during operative period and length of hospital stay. However, few cost and outcome analytic studies could be found related to laparoscopic surgery. Therefore, the purposes of this study were to compare cost and outcome differences between traditional splenectomy and laparoscopic splenectomy. The design was retrospective case control study. Review of medical charts was used to collect data from subjects who need splenectomy from June 2000 to April 2004 in a medical center of northern Taiwan. Cost items included costs of hospitalization, diagnosis, treatment, anaesthesia, medicine, and special materials. Outcomes were measured by length of hospital stay, times for operation, blood loss, and complications and hospital readmission after surgery. The sources of costs were from the health insurance reimbursement at study hospital by the Bureau of National Health Insurance. Data were analyzed by the statistical packages, SPSS/Windows Version 11.0 in Chinese. Descriptive statistics such as percent, mean, and standard deviation were used to understand subject’s demographics. The comparative statistics such as Chi-square test and independent sample t test were used to examine the difference between two types of surgery. Fifty-eight medical charts were reviewed in this study, 30 patients received traditional splenectomy and 28 patients for laparoscopic splenectomy. Among the traditional splenectomy group, the majority of subjects were women (n=21; 70%), under age of 21 (n=16; 53.3%) with mean age of 29.2years, junior high school (n=17; 56.7%), and single and married were equal (n=15; 50%). About 27patients 90.0%）had not any chronic diseases.In contrast, in the laparoscopic splenectomy group, the majority of patients were women (n=24; 85.7%), age between 21to 40 years of old (n=21; 46.4%) with mean age of 31.5years, above high school graduates (n=19; 67.8%) and married (n=18; 64.3%). However, no one has any chronic diseases. Although the total costs of laparoscopic splenectomy (NTD$34,122.1) was slightly higher than traditional splenectomy (NTD$31,057.8), no significant difference was found (p=0.077). For the outcomes, patients who received laparoscopic splenectomy had longer length of hospital stay and larger volume of blood loss than those of traditional splenectomy; however, no significant difference was found.(p>.05). Only the laparoscopic splenectomy group has significantly longer operation time than the traditional splenectomy group (p=.0001). For both groups, there were no any complications or readmission occurred after surgery. The findings of this study demonstrate that although there is a slightly difference in operational time, both types of surgery are equal and can be used for patients who need splenectomy. Therefore, the results can be an alternative choice for any one who need splenectomy and provide information to decision-makers for future revision of health payment system.