胆囊切除术病人实施临床路径的影响因素分析

目的]探讨可能影响胆囊切除术临床路径的因素，分析影响胆囊切除术住院天数和住院费用的主要因素，识别，临床路径中的变异。方法]调取2003年6月-2004年6月胆囊切除手术病历206份资料信息，对病人年龄、性别、诊断、术前合并症、手术时机、术式、输液量、术后并发症、住院天数、住院费用等进行单因素及多元回归分析，筛选出影响住院天数和住院费用的主要因素。结果]单因素分析显示：手术时机、术前合并症对住院天数的影响存在统计学差异；年龄、诊断、术前合井症、术弋、手术时机对住院费用的影响存在统计学差异。多元逐步回归分析显示：对住院天数有影响的4个主要因素是术后并发症、术前合并症、手术时机、术式，其中术后并发症影响最大；对住院费用有影响的4个主要因素是术式、输液天数、术后并发症、住院天数，其中术式影响最大。结论]年龄、诊断、手术时机、术前合并症、输液天数、术前住院天数、术后住院天数、术式等是单纯胆囊切除术临床路径中影响住院天数和住院费用的变异因素。

Analysis on influencing factors of clinical pathway for patients undergoing cholecystectomy

Objective： To probe into the possible influencing factors of clinical pathway for cholecystectomy, and analyze the main factors that influenced the length of hospital stay and hospital costs of patients undergoing cholecystectomy and identify the variances in clinical pathway. Methods：The information of the 206 operation patients undergoing cholecystectomy from June 2003 to June 2004 was took,univariate and multivariate regression analysis was carried out for the age, gender, diagnosis, preoperative complications, operative opportunity, operation style, the amount of transfusion, postoperative complications, hospital stay and hospital charges, and the main influencing factors of hospital charges and hospital stay were screened. Results： The univariate analysis showed there was statistical significant difference in the influence between preoperative complications and operative opportunity ; there was statistical sig- nificant difference in influence of age, diagnosis, preoperative complica- tions, operative opportunity and operation style. Stepwise multiple regression analysis showed the main influencing factors of hospital day were operation style, Infusion days postoperative complications and hospital stay, the effect of operation style was the biggest. Conclusion：The age, diagnosis, preoperative complications, operative opportunity, opera- tion style, infusion days, preoperative and postoperative complications were the variances influencing the hospital stay and hospital charges in clinical pathway of simple cholecystectomy.