ABSTRACT
Resumen Introducción: Las hernias son patologías muy frecuentes en un Servicio de Cirugía General (SCG); su tratamiento y costes son muy diferentes, dependiendo del cirujano, si hay hospitalización (CH) o cirugía mayor ambulatoria (CMA). Objetivo principal es el estudio de costes-resultados y de coste-efectividad de las hernias de pared abdominal (no pericolostómicas) realizadas por el SCG. Materiales y Método: Estudio descriptivo, longitudinal, observacional y retrospectivo. Intervenidas 370 hernias de pared abdominal, del 1 de octubre de 2015 al 30 de septiembre de 2016; seguimiento postquirúrgico hasta el 30 de octubre 2016 (1 a 12 meses). Resultados: 79,4% varones, media 59,95 años, 51,90% ASA II, 55,8% anestesia local, 59,72% hernias inguinales, 36,94% hernias inguinales unilaterales indirectas, 55,17 minutos por intervención, 54,44% por CMA, 4,77 días de estancia media en ingresados. Complicaciones perioperatorias 2,3%, tempranas 4,8% (5 reintervenciones) y tardías 12,8% (3 reintervenciones por recidiva). Altas 95,41%, tiempo medio 6,59 semanas. Coste de material de 109,87 € (hernia inguinal simple) hasta 370,41 € (eventración). Coste mediana quirófano 338,80 €. Coste/día CMA 807,30 € y con ingreso 1056,03 €. Mediana coste de hernia inguinal simple 422,69 € y de eventración 709,89 €. Mediana coste por complicación de hernia inguinal 1405,81 € y de eventración 8350,88 €. Mediana coste por proceso con CMA 1213,98 € y con ingreso 3689,80 €. Conclusión: Intervenciones de hernia inguinal unilateral simple, crural y umbilical, con técnica libre de tensión, material protésico, sin drenaje, CMA, anestesia local (con/sin sedación) y sin complicaciones resultan las más coste-efectivas (mejor relación coste-benefcio y coste-efectividad).
Introduction: Hernias are very frequent pathologies in a General Surgery Service (GSS); its treatment and costs are very different, depending on the surgeon, if there is admission (SH) or major outpatient surgery (MOS). A) Main objective. Study costs of (non-pericolostomic) abdominal wall hernia surgical procedures in the GSC (cost-outcome ratio and the cost-efectiveness). Materials and Method: Descriptive, longitudinal, observational and retrospective study. Abdominal wall hernias treated between 1st October, 2015 and 30th September, 2016; after surgery follow up until 30th October, 2016 (1 to 12 months). In total 370 hernia surgeries were performed. Results: 79.4% of males, mean 59.95 years, 51.90% of ASA II, 55.8% local anesthesia, 59.72% inguinal hernias, 36.94% indirect unilateral inguinal hernias, 55.17 minutes for surgeon, 54.44% for MOS, 4.77 days of average stay in admitted patients. Perioperative complications 2.3%, early 4.8% (with 5 reoperations) and late 12.8% (3 reinterventions due to relapse). 95.41% discharge, mean time 6.59 weeks. Material costs vary from €109.87 (simple inguinal hernia) to €370.41 (eventrations). Median surgery room cost €338.80. Cost/day MOS €807.30 and with income €1056.03. Median cost of simple inguinal hernia €422.69 and eventration €709.89. Median cost due to inguinal hernia complication €1405.81 and eventration €8350.88. Median cost per process MOS € 1213.98 and that of SH €3689.80. Conclusion: The interventions of simple unilateral inguinal hernia, crural and umbilical, using a tension-free technique, prosthetic material, without drainage, MOS, local anesthesia (with/without sedation) and without complications are the most cost-efective (better cost-beneft and cost-efectiveness ratio).
Subject(s)
Humans , Male , Female , Cost Efficiency Analysis , Cost-Benefit Analysis , Hernia, Abdominal/surgery , Hernia, Abdominal/economics , Spain , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies , Aftercare , HospitalizationABSTRACT
Efficiency, one of the key principles of economic assessment in the health service sector, has three implications: technical efficiency, cost efficiency and allocation efficiency. The paper gives an account of the various interpretations of some relevant concepts and different assessment methods. The following methods are frequently used to measure technical efficiency: ratio analysis, CPD, comprehensive index, DEA, etc. Economic efficiency is measured by production function while CEA, CUA and CBA are used to assess cost result. The major indexes for assessing allocation efficiency include the proportion between medical and preventive services, the proportion between basic and non basic medical services and the flow direction of total health expenses.