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2017年第8期
不同主刀医生对高龄髋关节置换术结果的影响分析
The analysis of any differences in outcome between of the elderly hip arthroplasty performed by different grade surgeons
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DOI:
作者:
杨雪 李萍
YANG Xue, LI Ping
作者单位:
同济大学医学院 上海浦东光明中医院,上海健康医学院附属周浦医院
School of Medicine, Tongji University,Shanghai,China
关键词:
不同主刀医生 髋关节置换术 影响分析
Different grade surgeons; Hip arthroplasty;Impact Analysis
摘要:
目的 了解不同年资主刀医生对高龄股骨颈骨折患者实施髋关节置换术之间的差异。方法 选择2010年至2015年某医院骨科高年资、中年、青年医生所主刀的高龄髋关节置换手术314例病历,对各医生组的平均住院费用、平均住院日、术前等待日、手术时长、术中出血量、术后住院时间、是否术中输血、术后并发症的发生率及出院后30天再入院率等9项指标进行回归性分析并通过统计学检验不同主刀医生组间是否存在差异。 结果 共获得全髋关节置换有效病历128例、半髋关节置换有效病历186例,共计314例,年龄60~95岁。青年医生组的全髋关节置换术病人数明显低于高年资和中年医生组的病人,半髋关节置换术三组病人量相当;高年资医生组的病人住院费用低于中年和青年医生组,差异有显著性;但在平均住院日、术后住院时间、手术时长、术后输血比例等医疗资源消耗指标中,高年资医生组高于中年医生组和青年医生组,差异有统计学意义;在手术质量和效果方面,三组医生之间的差异是无统计学意义的。在手术时机的选择和术中出血、术后输血比例及平均住院日等医疗资源的消耗上,三组医生均明显高于最新文献报道的平均值。结论 在相同诊断、相同治疗组中,因主刀医生的不同,医疗资源的消耗也会发生较大的差异。高年资组的医生在给予病人检查、治疗、输血等方面表现出更加谨慎和保守的态度,反而会更多地占用医疗资源;中、青年医生组在接受新的技术的同时,应更加注重循证医学的证据,控制医疗成本的增加。
Objective To study the differences of hip replacement for elderly femoral neck fracture patients between different grade surgeons. Methods Samples are collected the 314 hip replacements during 2010-2015 for patients over 60 years old which operated by high qualification, middle-aged and young orthopedist from a certain hospital. Collected 9 indexes of three different grade surgeon groups, including: average hospital cost, average length of stay, waiting days before surgery, operative time, intraoperative blood loss , days from OR to discharge, whether transfused, the rate of post-operative complications and rehospitalization rate in 30 days after hospital discharge. By statistical tests whether there is a difference between three surgeon groups. Results Obtained effective cases total hip replacement is 128, half hip replacement is 186, 314 in total, aged 60 and 95. Young doctors group of total hip replacement patients lower than the high qualification and middle-aged doctor group in number. Three groups of half hip replacement patients have the same number. Hospital cost of high qualification doctor group is lower than middle-aged and young doctors group, with significant difference. In the medical resource consumption indexes, average hospital cost, days from OR to discharge, operation time and transfused rate of high qualification doctor group is higher than middle-aged doctor and young doctors group, the difference was statistically significant. In terms of operation quality and effect, the differences between the three groups is not significant.In the medical resource consumption indexes, the choice of operation time, intraoperative blood loss, transfused rate and average length of stay were significantly higher than the latest literature reported. Conclusion The consumption level of medical resource could be very different when operated by different doctors even they come from same treatment group and with same diagnose. Doctors from senior group shows more cautious and conservative attitude when examining patients, offering treatment proposal and on blood transfusion ect. And those lead to more consumption of medical resources; and for middle level and junior lever doctor group, while exploring new technology, they should pay more attention to the evidence of evidence-based medicine, and to control medical cost.
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