담낭절제술의 시술방법 차이에 따른 재원기관 및 진료비

Abstract

[한글]

담낭절제술의 개복·복강경방법의 차이에 따른 재원기간과 진료비를 비교 분석하고자 한 의과대학 부속병원에서 1991∼1994년 사이 담석증을 주진단으로 담낭절제술을 받은 환자 336명을 대상으로 의무기록지와 전산실 진료비 자료를 이용하여 분산 분석과 x**2 -검정 및 다변수회귀분석등으로 분석하였다.

1. 담낭결석환자에게 1991년 12월에 처음 시행되었던 복강경담낭절제술은 그 이후 매년 시술수가 증가하여 기존의 담낭절제방법이었던 개복담낭절제술을 빠르게 대체해 가고 있다.

2. 담낭절제술의 재원기간은 복강경담낭절제술의 수술후 재원기간, 총재원기간이 개복담낭절제술보다 유의하게 짧았다. 담낭절제술의 진료비는 총진료비의 경우 개복담낭절제술이 복강경 담낭절제술보다 유의하게 많았고 일일평균진료비의 경우 복강경 담낭절제술이 개복담낭절제술보다 유의하게 많았다.

3. 담낭절제술의 재원기간을 결정하는 요인으로는 총 7가지 변수가 유의하였는데, 개복담낭절제술을 기준으로 할 때 복강경담낭절제술은 재원기간을 짧게 결정짓는 요인이었다 이 7가지 변수는 재원기간을 총 39.4% 설명하였다.

담낭절제술의 진료비를 결정하는 요인으로는 총 7가지 변수가 유의하였는데 개복담낭절제술을 기준으로 할 때 복강경 담낭절제술은 진료비를 적게 결정짓는 요인이었다. 이 7가지 변수는 진료비를 총 32% 설명하였다.

앞으로 복강경담낭절제술은 병원경영의 효율화를 위해 계속 장려되어야하며 그 시술의 적용대상 질병을 확대해 갈 수 있도록 기술을 발전시키는데 역점을 두어야 할 것이다.

[영문]

This study attempts to analyze the length of stay and hospital charges which depend on open cholecystectomy and laparoscopic cholecystectomy,

Data were collected from records of hospital discharges and medical records of 336 patients who were hospitalized with cholelithiasis and received open cholecystectomy or laparoscopic cholecystectomy at a university medical center from April 1, 1991 to March 31, 1994.

These were studied statistically by means of ANOVA, x2-test and multiple regression.

The following results from this study were obtained.

1. Laparoscopic cholecystectomy has been performed at this hospital since December, 1991. In thesedays, laparoscopic cholecysectomy emerged as an alternative to open cholecystectomy.

2. Pre-operative and the total length of stay of laparoscopic cholecystectomy was siginigicantly shorter than that of open cholecystectomy. In the total hospital charges, open cholecystectomy was significantly higher than laparoscopic

cholecystectomy Otherwise, open cholecystectomy was lower than laparoscopic cholecystectomy in average hospital charges per day. Both the costs data of the total hospital charges and the average hospital charges per day are statistically significant respectively

3. There was no statistically significant difference between open cholecystectomy and laparoscopic cholecystectomy by variables of combined diagnoses, laparotomy history, department transfer, operation character(urgent or elective), and accomodation except these two variables of consultation and admission route.

4. From the multiple regression analysis on length of hospital stay, the following seven variables were statistically significant for cholecystectomy; age, combined diagnoses, operation character (urgent or elective), department transfer,

consultation, operation methods (open or laparoscopic cholecystectomy) and accomodation. These variables explained 39.4% of the length of stay for cholecystectomy. on hospital charges, the following seven variables were statistically significant for cholecystectomy; age, admission route, combined

diagnoses, department transfer, consultation, operation methods (open or laparoscopic cholecystectomy) and accomodation. The sevariables explained 32% of the total hospital charges for cholecystectomy.

In conclusion, laparoscopic cholecystectomy was of distinct advantages to patients and to the effective hospital management. Therefore we should develop the surgical technology of laparoscopic cholecystectomy and encourage the use of it, too.