背景:单室膝关节置换术(UKR)的日间手术可能会降低住院费用。我们旨在衡量引入一天手术UKR途径对英国NHS的平均住院时间(LOS)和费用的影响,与加速的住院路径相比。其次,该研究旨在使用三种成本计算方法比较成本的大小:自上而下的成本计算;简单的微观成本计算;和现实世界的成本计算。
方法:我们进行了一项观察,对一家NHS医院的2,111例UKR患者进行的研究前后:2017年9月至2020年2月期间,1,094例患者采用日间手术路径;2013年9月至2016年2月期间,1,017例患者采用加速住院路径.自上而下的成本是使用平均NHS成本估算的。简单的微观成本计算使用了每个床日的成本。该中心的实际成本是通过计算人员配置水平的实际变化来估计的。
结果:白天手术路径中的532例(48.5%)患者在手术当天出院,而加速住院路径中的36例(3.5%)患者出院。日间手术路径将平均LOS降低了2.2(95%CI:1.81,2.53)晚,并且与平均NHS成本降低18%相关(p<0.001)。使用平均NHS成本方法,每位患者平均节省1,429英镑,每位患者905英镑,采用微观成本计算方法,每位患者577英镑,采用“真实世界”成本计算方法。总的来说,将NHSUKR手术转移到日间手术途径可以节省NHS每年8,659,740英镑。
结论:UKR的日间手术可以为医院和NHS节省大量成本。
BACKGROUND: Day surgery for unicompartmental knee replacement (UKR) could potentially reduce hospital costs. We aimed to measure the impact of introducing a day surgery UKR pathway on mean length of stay (LOS) and costs for the UK NHS, compared to an accelerated inpatient pathway. Secondly, the study aimed to compare the magnitude of costs using three costing approaches: top-down costing; simple micro-costing; and real-world costing.
METHODS: We conducted an observational, before-and-after study of 2,111 UKR patients at one NHS hospital: 1,094 patients followed the day surgery pathway between September 2017 and February 2020; and 1,017 patients followed the accelerated inpatient pathway between September 2013 and February 2016. Top-down costs were estimated using Average NHS Costs. Simple micro-costing used the cost per bed-day. Real-world costs for this centre were estimated by costing actual changes in staffing levels.
RESULTS: 532 (48.5%) patients in the day surgery pathway were discharged on the day of surgery compared with 36 (3.5%) patients in the accelerated inpatient pathway. The day surgery pathway reduced the mean LOS by 2.2 (95% CI: 1.81, 2.53) nights and was associated with an 18% decrease in Average NHS Costs (p < 0.001). Mean savings were £1,429 per patient with the Average NHS Costs approach, £905 per patient with the micro-costing approach, and £577 per patient with the \"real-world\" costing approach. Overall, moving NHS UKR surgeries to a day surgery pathway could save the NHS £8,659,740 per year.
CONCLUSIONS: Day surgery for UKR could produce substantial cost savings for hospitals and the NHS.