吉尔吉斯共和国的快速实施经验

K. Ysmaiylov, K. Tashiev, S. Abdiraimuulu, T. Abdyldaev
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摘要

快速通道(FTP)旨在缩短急诊手术的住院时间并降低总体成本,目前正越来越多地在急诊手术中实施。本研究旨在评估奥什国立大学临床医院(OSU CH)急诊普外科快速通道的实施情况。研究对象包括2020年至2023年期间在奥什国立大学临床医院接受腹腔镜阑尾切除术(LA)、腹腔镜胆囊切除术(LC)或腹腔镜腹股沟疝修补术(LI)的98名患者。FTP组由71名患者组成,在实施FTP前评估了76个对照病例的数据。对各组的手术时间(TTS)、住院时间(LOS)和总住院时间进行了比较。此外,还对直接成本、报销和患者满意度(从 1 = 从不到 4 = 始终)进行了评估。样本中有 60.6% 为女性,中位年龄为 40 岁。病例分布略有不同(LA 为 56.2% vs 42.1%,LC 为 40.4% vs 57.9%,FTP vs 对照组),但两组的手术时间相似(11 小时 39 分钟 vs 10 小时 2 分钟,P = 0.633)。FTP 组的术后 LOS 明显缩短(15 小时 17 分钟 vs 29 小时 9 分钟,P <0.001),反映出住院时间缩短(3 小时 11 分钟 vs 20 小时 10 分钟,P <0.001),需要住院床位和过夜的患者减少(P <0.001)。FTP 组的直接费用明显降低,而报销额度相当(分别为 P < 0.001 和 P = 0.999),患者平均满意度很高(3.3/4)。在降低成本、优化资源和提高患者满意度的时代,FTP 可在急诊住院治疗中发挥重要作用。在 OSU CH,FTP 显著减少了住院时间和病床使用率,同时不影响报销或患者满意度。
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Fast-track Implementing Experience in the Kyrgyz Republic
Fast Track Pathways (FTP) aimed at reducing length of stay and overall costs are increasingly being implemented for emergency surgeries. The objective of this study was to evaluate the implementation of a FTP for emergency general surgery at the Osh State University Clinical Hospital (OSU CH). The study included 98 patients at OSU CH from 2020 to 2023 who underwent laparoscopic appendectomy (LA), laparoscopic cholecystectomy (LC), or laparoscopic inguinal hernia repair (LI). The FTP group comprised 71 patients, with data from 76 control cases assessed prior to FTP implementation. Comparisons were made between time to surgery (TTS), length of stay (LOS), and total length of stay between groups. Direct costs, reimbursements, and patient satisfaction (rated from 1 = never to 4 = always) were also evaluated. The sample comprised 60.6% females with a median age of 40 years. Case distribution varied slightly (56.2% vs 42.1% for LA, 40.4% vs 57.9% for LC, FTP vs control), yet time to surgery was similar between groups (11 hours 39 minutes vs 10 hours 2 minutes, P = 0.633). Postoperative LOS was significantly shorter in the FTP group (15 hours 17 minutes vs 29 hours 9 minutes, P < 0.001), reflecting reduced hospital stay (3 hours 11 minutes vs 20 hours 10 minutes, P < 0.001), with fewer patients requiring inpatient beds and overnight stays (P < 0.001). Direct costs were significantly reduced in the FTP group, while reimbursements were comparable (P < 0.001 and P = 0.999, respectively), and average patient satisfaction was high (3.3/4). In an era of cost reduction, resource optimization, and patient satisfaction, FTP can play a significant role in emergency hospitalization. At OSU CH, FTP significantly reduced hospital stay and bed utilization without impacting reimbursements or patient satisfaction.
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