良性骨腫瘍手術例における入院期間の検討―現在の診断群分類包括支払制度の問題点

Clinical Investigation of Length of Hospital Stay for the Surgical Treatment of Benign Bone Tumors

　目的と対象：良性骨腫瘍手術60例について，入院期間を上肢例と下肢例に分けて比較し，診断群分類包括支払制度(以下，DPC)における特定入院期間超過例の割合や傾向を明らかにすべく検討を行った．

　結果：上肢例の平均入院期間は10.2日，骨巨細胞腫を除く下肢例は18.5日，下肢骨巨細胞腫例は61.2日であり，特定入院期間超過例は上肢例で21.4％，骨巨細胞腫を除く下肢例で38.2％，下肢骨巨細胞腫例で100％であった．

　まとめ：DPCにおいて良性骨腫瘍が含まれる診断群分類は，腫瘍の発生部位に関わらず一定の特定入院期間を設定しているが，腫瘍の発生部位に応じた特定入院期間の設定が望まれる．

　Methods：As a means of assessing the diagnosis procedure combination (DPC) used by the national medical insurance system in Japanese hospitals we evaluated the length of hospital stay of 60 patients for surgically treatment of benign bone tumors.

　Results：The average length of stay for patients whose tumor was in an upper extremity was 10.2 days, as opposed to 18.5 days when the tumor in a lower extremity, with the exception of giant cell tumors of bone was giant cell tumors (GCTs), and it was 61.2 days for GCTs of the lower extremity.　The DPC was not applied to 21.4% of the cases of upper extremity involvement, and it was not applied to 38.2% of the cases of lower extremity involvement with the exception of GCTs, or to 100% of the cases of GCT of the lower extremity.

　Conclusion：The upper limit of hospital stay for which the DPC is applied is the same irrespective of the site of the tumor.　We suggest that a new DPC classification of benign bone tumors be made that takes into account the site of the tumor.