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目的 分析北京协和医院神经外科纳入KC19组的垂体手术患者住院费用影响因素，为细化疾病诊断相关分组(diagnosis related groups，DRG)提供参考。 方法 回顾性分析2017年1月1日至2021年11月30日北京协和医院神经外科垂体手术患者的病案首页信息，采用描述性统计、单因素分析、多因素线性回归分析患者住院费用相关影响因素。 结果 本研究共纳入垂体手术患者3809例，平均住院费用为36 166.82元，平均住院天数为9.42 d；应用神经内镜手术的患者占比35.2%，存在严重并发症或合并症(major complication or comorbidity，MCC)/并发症或合并症(complication or comorbidity，CC)的患者占比40%；单因素分析发现住院费用与患者性别、住院天数、其他诊断数量、手术操作数量、是否应用神经内镜及是否存在MCC/CC有关；多因素分析发现住院费用的主要影响因素为住院时长，其次分别为其他诊断数量、手术操作数量、是否应用神经内镜、是否存在MCC/CC及性别。 结论 在DRG支付方式下，KC19组的细化应着重考虑其影响因素，患者是否应用神经内镜及是否存在MCC/CC应纳入分组标准。 Abstract:Objective To analyze the influencing factors of hospitalization expenses of patients treated in the KC19 group by the neurosurgery department of a tertiary hospital in Beijing, and provide reference for the refinement of diagnosis related groups(DRG). Methods The medical records of 3809 patients from January 1, 2017 to November 30, 2021 were reviewed, and relevant influencing factors were determined using descriptive statistics, univariate analysis, and multivariate linear regression. Results Among the 3809 patients included in this study, the average total hospitalization cost was 36 166.82 yuan, and the average hospital stay was 9.42 days. Neuroendoscopy accounted for 35.2%, while major complications or comorbidities (MCC) and complications or comorbidity (CC) accounted for 40%. Univariate analysis found that hospitalization costs were associated with gender, length of hospital stay, number of other diagnoses, number of surgical procedures, use of neuroendoscopy, and the presence of MCC or CC. Multivariate analysis found that the main influencing factors were the length of hospital stay, followed by the number of other diagnoses, the number of surgical operations, whether neuroendoscopy was used, whether there was MCC or CC, and gender. Conclusion In the follow-up fine grouping of KC19, the above influencing factors should be considered, and the use of neuroendoscopy and the presence of MCC or CC should be included in the grouping criteria. -
Key words:
- diagnosis related groups /
- hospital costs /
- pituitary tumor
作者贡献：杨朗、魏俊吉、张国杰、李春厚负责论文构思；杨朗负责论文撰写；魏俊吉、银锐、文俊贤、常健博、陈亦豪、张笑、马文斌、王任直负责论文审阅及修订。利益冲突：所有作者均声明不存在利益冲突 -
表 1 KC19组垂体手术患者基本资料(n=3809)
类别 例数[n(%)] 性别 男 1519(39.9) 女 2290(60.1) 年龄(岁) ＜65 3538(92.9) ≥65 271(7.1) 住院天数(d) ＜5 725(19) 5~10 2169(57) ≥10 915(24) 其他诊断数量(个) ＜3 1713(45) ≥3 2096(55) 手术操作数量(个) ＜3 2451(64.3) ≥3 1358(35.7) 应用神经内镜 否 2469(64.8) 是 1340(35.2) 存在MCC/CC 否 2286(60) 是 1523(40) 注：MCC/CC：严重并发症或合并症/并发症或合并症 
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表 2 KC19组垂体手术患者住院费用主要影响因素
指标 非标准化回归系数 标准化回归系数 t值 P值 VIF值 常量项 4.405 676.091 - 性别 0.009 -0.022 -2.051 0.040 1.018 住院天数 0.005 0.565 36.414 ＜0.001 2.064 其他诊断数量 0.007 0.165 11.959 ＜0.001 1.625 手术操作数量 -0.011 0.105 7.538 ＜0.001 1.650 是否存在MCC/CC 0.019 -0.045 -3.593 ＜0.001 1.321 是否应用神经内镜 -0.005 0.083 7.326 ＜0.001 1.091 注：MCC/CC：同表 1；VIF：方差膨胀系数
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