Comparative Evaluation of Intraoperative and Postoperative Parameters in Laparoscopic vs Open Appendicectomy in Cases of Acute Appendicitis

Background: Appendectomy is the most common surgicalprocedure performed in emergency surgery. Appendectomy isstill being performed by both open (OA) and laparoscopic (LA)methods as no other technique is formulated. In this study, weaimed to compare the laparoscopic procedure and thestandard technique in the treatment of acute appendicitis.Methods: Retrospectively collected data from 60 consecutivepatients with acute appendicitis were studied. These comprised30 patients who underwent conventional appendectomy and 30patients treated laparoscopically. The two groups werecompared for Intra operative parameters like duration ofsurgery, conversion, complications, and post-operativeparameters like pain, requirement of pain medications, woundcomplications, hospital stay, any other complications, andcosmetic outcome.Results: In our study Laparoscopic Appendectomy have ashorter hospital stay (Mean duration of hospital stay aftersurgery was 3.1 & 1.9 day in OA & LA group respectively),Operative time was significantly less in the open group (Meanduration of surgery was 71.2 minutes in OA group and 48.8minutes in LA group). Total number of complications werefewer in the LA group with a significantly less incidence ofwound infection (5 Vs 11, P <0.04).Conclusion: The laparoscopic method is a safe andcompetent operative method in appendicectomy. Postoperativepain in our study is notably lesser in laparoscopic group ascompared to open appendectomy, also post-operativecomplication especially wound infections are less frequent inlaparoscopic group of patients. Patient’s recovery fromoperation is also better in laparoscopic appendicectomy groupwhich includes early bowel activity, minimum hospital stay andearly return to work. Overall cosmetic outcome is preferable inlaparoscopic group of patients.

Robotic lung resection for malignant and benign lesions: experience with 1 000 patients / 中国胸心血管外科临床杂志

@#Objective To analyze the perioperative outcome of consecutive 1 000 patients undergoing robotic lung resection and summarize surgical experience. Methods We retrospectively reviewed the clinical data of 1 000 patients undergoing robotic lung resection between May 2009 and June 2018 in Shanghai Lung Tumor Clinical Medical Center. Robotic lobectomy was compared with traditional VATS over the same period using a propensity-matched analysis. There were 327 males and 673 females at average age of 56.21±11.33 years. Lobectomy was performed in 866 patients (11 bilobectomy included), sublobar resection was performed in 129 patients, sleeve lobectomy was performed in the remaining 5 patients. Pathology was as follows: adenocarcinoma in 875 patients, squamous carcinoma in 52 patients, benign tumors in 73 patients. 90.5% of the primary lung cancer were in stage Ⅰ. Results The mean operative time was 90.31±19.70 min; 95.70% of patients’ estimated blood loss was less than 100 ml. Conversion rate to thoracotomy was 0.90% (9 patients) . The average lymph node station and count harvested was 5.59±1.36 and 9.60±3.21 respectively. The mean volume of chest tube drainage on the first postoperative day was 229.19±131.67 ml. Median chest tube time was 3.85±1.43 d. There was 1 in-hospital death due to pulmonary embolism. A total of 189 patients had postoperative complications (18.90%) whose majority was postoperative air leak more than 5 days. The mean overall hospital costs was 92 710.53±12 367.23 Yuan. Compared with VATS, RATS was associated with significant reduction in intraoperative blood loss, time to chest tube removal and postoperative hospital stay. The operative time, conversion rate, lymph nodes removed, morbidity and mortality were similar between the two groups. Conclusion Robotic-assisted lung resection is safe and effective with low conversion rate and less complications, and it can overcome many disadvantages of traditional VATS.

Evolução na utilização e nos gastos de uma operadora de saúde / Evolution in the use and the expenditures of a healthcare provider

Resumo O envelhecimento da população e o crescimento no número de pessoas expostas aos cuidados do sistema de saúde suplementar no Brasil aumentam a preocupação dos gestores públicos e privados com o crescimento dos custos da área de saúde. Neste trabalho foram analisados os custos por gênero, por tipo de gasto médico e por faixa etária de uma operadora de autogestão brasileira no período entre 2007 a 2013. Tal operadora é de grande interesse pois além de retratar uma condição única de restrição de crescimento de receita, também replica o perfil demográfico esperado para o Brasil no ano de 2050, quando aproximadamente um terço da sua população estará acima dos 60 anos. As análises corroboram a literatura vigente uma vez que demonstram um aumento na utilização do plano pelos mais idosos, e apontam para uma diferença nas taxas de internação entre os gêneros. O estudo também mostra um expressivo aumento no tempo médio de permanência nos hospitais e mostra crescimento dos gastos médicos muito acima da inflação, com destaque para materiais e medicamentos. No geral, esperamos que o presente estudo auxilie estudiosos e interessados em futuras comparações dos gastos médicos por idade e gênero e que colabore na sustentabilidade das operadoras de saúde no Brasil.

Abstract Brazil's aging population and the rising number of people reliant upon the country's supplementary healthcare system have elicited the concern of public and private managers regarding the increase in healthcare costs. In this paper, the costs per gender, per type of medical expenses and per age group of a major Brazilian self-managed healthcare provider between 2007 and 2013 were analyzed. This healthcare provider is of interest because, besides portraying a single condition of revenue growth restricted to the existing contributors, it also replicates the demographic profile expected for Brazil in 2050, when approximately one-third of its population will be over 60 years of age. The analyses confirm the current literature as they show an increase in healthcare plan usage by the elderly and the difference between admission rates by gender. They also reveal an increase in average length of stay in hospital and the increase in medical costs far above inflation, especially for materials and medicines. It is hoped that this study will help scholars and others interested in comparisons of medical expense trends, especially by age and sex, and that it encourages further collaboration on the sustainability of health insurance providers in Brazil.

Review on the pay for performance impact on hospital costs / 中国卫生政策研究

Objective:To analyze the pay for performance related costs and provide suggestions for further stud-y. Methods:Empirical literatures from inside the country and overseas were collected with a systematic review. Costs were summarized on the basis of three drivers ( performance appraisal, performance improvement and incentive per-formance) . Results:A total of 141 papers, 47 in Chinese and 94 in English were enrolled. Most papers in Chinese were subjected on healthcare facilities while the English ones emphasized on hospitals. Pay for performance may lead to the healthcare service costs, regulation costs and the resources allocation related costs reduction. In addition to these visible costs, a large amount of others hidden from different hospital management levels were also due to pay for performance. Conclusions:(1) Differences in costs could be found from home and overseas experience which per-haps resulted from the pay for performance, the supporting measures and the policy development. (2) More attention should be paid to the quantification researches on the health facilities’ hidden costs. (3) Most available researches fo-cus on pay for performance cost-effectiveness from the society and service purchase but not the providers’ perspective and the hidden costs were also ignored.

Impacto socioeconómico del Caulophyllum en pacientes con inmadurez cervical / Social and economic impact of Caulophyllum in patients with cervical immaturity

Se realizó un estudio descriptivo y transversal de 1 994 mujeres, ingresadas en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider", de Santiago de Cuba, desde enero del 2011 hasta diciembre del 2012, con vistas a valorar el tratamiento con Caulophyllum en la maduración cervical y propiciar el trabajo de parto espontáneo antes de las 42 semanas o la respuesta positiva a la inducción, así como la determinación del impacto socioeconómico de este método. En la casuística disminuyeron las inducciones y cesáreas, a la vez que se incrementaron los partos eutócicos, lo cual garantizó una mejor calidad en la atención a las pacientes, con menos gastos de recursos materiales y capital humano, así como también con reducción de los costos hospitalarios.

A descriptive and cross sectional study of 1 994 women, admitted in "Tamara Bunke Bider" Teaching Gynecological and Obstetrical Hospital in Santiago de Cuba was carried out from January, 2011 to December, 2012, with the aim of evaluating the treatment with Caulophyllum in the cervical maturation and to propitiate the spontaneous childbirth before the 42 weeks or the positive response to the induction, as well as the determination of the socioeconomic impact of this method. The inductions and caesarean sections decreased in the case material, at the same time eutocic childbirths were increased, which guaranteed a better quality in the care to these patients, with less expenses of material resources and human capital, as well as with reduction of the hospital costs.

Dolor y costos hospitalarios en la reparación de la hernia inguinal primaria: Lichtenstein frente a Desarda / Pain and hospital costs in primary inguinal hernia repair: Lichtensten versus Desarda

La hernia inguinal tiene una alta incidencia en la población y representa un problema de salud por sus importantes implicaciones sociales y laborales. El objetivo de este trabajo fue comparar los resultados del tratamiento de la hernia inguinal mediante dos técnicas quirúrgicas distintas: una protésica (técnica de Lichtenstein) y otra anatómica (técnica de Desarda), haciendo hincapié en la valoración del dolor posoperatorio y los costos hospitalarios de dichos procedimientos, además de otros factores. Se realizó un estudio prospectivo aleatorizado de 625 pacientes intervenidos quirúrgicamente entre enero de 2003 y enero del 2009 en el Hospital General Docente Dr Enrique Cabrera (La Habana). Fueron también estudiadas otras variables, como edad, localización y tipo de hernia, duración de la intervención y complicaciones. El tiempo quirúrgico fue menor en la hernioplastia de Lichtenstein y hubo un comportamiento similar en cuanto al dolor posoperatorio entre el primero y tercer día, y en la hernioplastia fue superior al quinto día. Se encontró diferencia estadísticamente significativa en cuanto al costo hospitalario, que fue superior con la técnica protésica. Con la técnica de Desarda se obtienen los mismos resultados satisfactorios en las hernias no recidivadas que con la técnica de Lichtenstein, y el costo hospitalario es menor(AU)

The inguinal hernia has a high incidence in population and represents a health problem due to its significant social and working implications. The objective of present paper was to compare the results of inguinal hernia treatment using two different techniques: a prosthetic one (Lichtenstein technique) and other of anatomical type (Desarda's technique) emphasizing on evaluation of postoperative pain and the hospital costs due to such procedures in addition to other factors. A randomized and prospective study was conducted in 625patients operated on between January, 2003 and January, 2009 in the Dr Enrique Cabrera General Teaching Hospital (La Habana). Other variables were also studied including the age, localization and the type of hernia, length of surgical intervention and the complications. The surgical time was minor in the Lischtenstein hernioplasty and there was a similar behavior as regards the postoperative pain between the first and the third day, and in the hernioplasty it was higher at fifth day. There was a significant statistic difference as regards the hospital cost that was higher using the prosthetic technique. With the Desarda's technique it is possible to obtain the same satisfactory results in non-relapsing hernias that with the Lichtenstein's technique and the hospital cost is minor(AU)

Calculation of Costs of Pregnancy- and Puerperiumrelated Care: Experience from a Hospital in a Low-income Country.

Calculation of costs of different medical and surgical services has numerous uses, which include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services.

Improvement of Hospital Management through the Introduction of Hospital Cost Accounting in Sri Lanka / 国際保健医療

<b>Background and objectives</b><br> Effective hospital management requires utilizing limited medical resources to repeatedly make decisions based on information by hospital administrators, and to achieve the hospital's goals on the mission statement. <br> Therefore, one of the most important duties performed by hospital management experts is to develop an evidence-based information reporting system in a comprehensive manner for decision-making. The following report explains this process to introduce department-based cost accounting to hospitals in Sri Lanka, from the viewpoint of sorting data. <br><b>Process</b><br> During the development survey phase II in the “Evidence-based Management for the Health System in Sri Lanka” which was conducted from October 2005 to October 2007, one national hospital (a tertiary care institution) and one district hospital (a secondary care institution) were selected as pilot hospitals in the Northwest Province of Sri Lanka. After conducting a survey on the present situation of medical treatment information and accounting information, a department-based cost accounting system was introduced. Thus, a system to prepare a monthly report was developed. <br><b>Results</b><br> During this survey, the process was carried out whilst explaining to personnel of the Ministry of Health and the Ministry of Finance, the necessity of cost accounting in hospital management and its effective utilization in policy-making from the initial stage of the survey. However, not until the information was actually obtained and revealed by cost accounting (conducted at their own hospitals), could the Ministry of Health and the Ministry of Finance understand the importance and necessity of collection and analysis of detailed cost information such as the costs of medical and health care services.<br><b>Conclusion</b><br> By introducing a department-based cost accounting system to hospitals as a managerial accounting system, it was found that the information necessary for hospital management (covering accounting and medical treatment of the entire hospital) could be gathered and processed more efficiently. The activities by hospital management experts can be processed to sort and organize hospital data. Therefore, sorting data with the aim of department-based cost accounting is considered extremely useful as a basic duty by hospital management experts.