폐색성 좌측 대장암에서 단단계 술식의 경제성
The Economic Efficiency of the Single Stage Management of Left Colon Cancer Patient
강신화, 손대호, 권우형, 김상운, 심민철, 김재황,
소속 상세정보
강신화 ( Kang Shin-Hwa )
영남대학교 의과대학 외과학교실
손대호 ( Son Dae-Ho )
영남대학교 의과대학 외과학교실
권우형 ( Kwun Woo-Hyung )
영남대학교 의과대학 외과학교실
김상운 ( Kim Sang-Woon )
영남대학교 의과대학 외과학교실
심민철 ( Shim Min-Chul )
영남대학교 의과대학 외과학교실
김재황 ( Kim Jae-Hwang )
영남대학교 의과대학 외과학교실
KMID : 0356720020180040251
Abstract
Purpose: Two-stage management with Hartmann’s procedure is the most common procedure used for the treatment of obstructive left colon cancer with or without perforation. However, single-stage procedures have gained popularity recently with reports that show little difference in safety compared to the conventional multi-stage procedures. To evaluate the economic advantage of single stage procedure compare with two stage procedure in emergent left colonic pathology.
Methods: Eleven patients (SP; single stage procedure) without other accompanying diseases among 15 patients who entered the emergency room and treated by the single stage procedure using the intraoperative irrigation for the left colon obstructions with or without perforation during the period from July of 1999 to November of 2000, were compared in their costs retrospectively with 11 patients (MP; multiple stage procedure) without other accompanying diseases and had final reduction of stoma out of 28 patients treated by Hartman’s procedures including the resections of lesions during the period from September 1996 to May 1999 with the same diagnosis. The costs were compared using Mann-Whitney U tests, with data on the costs of overall treatments, operations, anesthesia, admission room, medications, test/evaluations, and managements as well as days of hospital stay, all on the record of accounting department. The relationships of the factors to the total cost of treatment were evaluated using Multi-variant regression analysis, and the pre-operative physiologic status were compared using APACHE Ⅲ scoring system. The total treatment cost did not include optional treatment costs, uninsured admission room costs, and the costs of colonic irrigator used in the operations for the SP.
Results: There were no significant difference in the age and gender of the two groups as 67±15 years with 6 males for the SP and 6±19 years with 7 males for the MP. The preoperative physiologic status of patients, in APACHE Ⅲ scoring system, were 29.1±10.6 in the SP and 26.1±8.2 in the MP without any significant difference between the two groups. The average of hospital stay showed a significant difference between two groups as 17.1±6.2 (range: 13∼25) days for the SP and 31.3 (range: 24∼43) days for the MP (P＜0.01). The average of total costs showed also a significant difference in two groups as 3,938±687 (range: 3,017∼4,974) thousand won for the SP and 7,543±1,851 (range: 5,314∼9925) thousand won for the MP (P＜0.01). It showed that the SP had roughly 50, 53, 76, 79, and 72% reductions of costs over operations, anesthesia, admission room, medications, tests/evaluations, and managements. The analysis of the overall costs of treatments showed 3,540 thousand won reduction in SP.
Conclusions: Single stage procedure using intraoperative colonic irrigation technique showed no difference in safety but has an economical advantage over the conventional multiple stage in the management of emergent left colonic
obstruction or perforation patients.
키워드
단단계 술식;결장암;직장암;수술 중 대장세척;경제성
Single-stage procedure;Colon cancer;Rectal cancer;Intraoperative colonic irrigation;Economic advantage
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