본 연구의 결과를 토대로 다음과 같이 제언을 한다.
1. 본 연구는 연구 대상이 일부 지역의 종합병원에 표본의 대표성이 미약할 수 있으므로, 연구 결과를 일반화하기 위해서는 특성이 다른 병원 조직 및 타 수술을 대상으로 반복 연구가 필요하다.
2 예방적 항생제 투여기간과 수술부위 감염 발생과의 관련성 분석은 무작위 임상연구 및 장기간의 추적관찰 연구를 통한 추가적인 근거 확립이 이루어져야 할 것이다. 이는 전향적 연구설계를 통한 정확한 자료분석을 통해 점검이 필요하다.
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3. 본 연구에서는 1 가지 수술을 대상으로 연구를 시행하여 결과를 객관화 하기에 어려움이 있다. 향후 국내에서 잘 설계된 전향적 무작위할당 임상연구를 통해 명확한 근거가 개발이 필요하다.
4. 본 연구에서 사용한 자료는 입원 건당 총 병원비이다. 따라서 병원비 중 진료비, 수술비, 주사 및 처치료, 투약비, 식대, 병실료 등의 항목 중 어떤 항목의 비용이 증가하였는지 알 수 없는 단점이 있었다. 향후 연구에서는 항목의 세분화를 통해 각 비용의 증감을 확인하는 연구의 진행이 필요하다.
5. 본 연구는 대상 환자의 규모가 작기 때문에 연구 결과를 보편적으로 적용하기는 어려울 것으로 생각하며 향후 대규모 환자를 대상으로 예방적 항생제의 환자 성과에 대해 분석하는 연구가 필요할 것으로 사료된다.
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참고문헌
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Abstract
Prophylactic antibiotics in patients with laparoscopic
cholecystectomy Patients according to clinical quality
indicators and analysis applied
Seo, Ryu Bin
Department of Nursing Management and Education Graduate School of Nursing
Yonsei University
Briefly prophylactic antibiotic is defined as all kinds of antibiotic used for patients who have high possibility of infection after surgery. The main purpose of prophylactic antibiotic usage is to prevent infection after surgery.
Therefore, it could minimize the number of days that patients having a weak immune system have to stay in hospital in order to fully recover from infection. Consequently, the medical expenses that the patients have to bear
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would be significantly reduced due to the fact that the usage of antibiotic would be minimized.
The entire research is performed based on two different laparoscopic cholecystectomy patients’ groups. One group is apply with prophylactic antibiotic clinical indicator, whereas the other group is not supported with prophylactic antibiotic. Then, it will compare and collate the output of observation for two different groups. Particularly, three aspects of analyzing observational data among patients will be focused in this research. Three factors are the possibility of surgical site infection, the hospitalized period after surgery, and the eligible medical expenses. The data is collected from August 1 2008 to July 1 2010, and the patients who have K80.2 Gallstone without cholecystitis, K81.1 Chronic cholecystitis, K82.9 GB Polyp are randomly chosen for collating data. Patients medicated with prophylactic antibiotic were hospitalized from August 1 2009 to July 30 2010. On the other hand, patients without any medical influence of prophylactic antibiotic clinical indicator were hospitalized from August 1 2008 to July 31 2009.
With regard to the possibility of surgical site infection, the similar results are observed among two groups. 4 patients(3.8 percents) are infected in the medicated group. Also, 4 patients(2.8 percent) are infected in non- medicated group. Moreover, the medical expense between two groups is not affected
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by prophylactic antibiotic treatment. In the medicated group, overall medical expense estimates 2,327,144.48 won. In non-medicated group, it costs 2,308,863.50 won. However, the hospitalized period after surgery is considerably impacted by prophylactic antibiotic treatment. Overall 2.77 days (±0.98%) are observed in medicated group, whereas 3.63 days (±33.2%) are analyzed with the information that non-medicated group provides(p=.016).
Through this study, antibiotic prophylaxis is recommended for clinical quality indicators are used to elicit a variety of patient outcomes and clinical quality indicators of development and care for patients through the activation of roll out will be helpful. In addition, this study as a retrospective observational study limitations of this study, so a large prospective study is suggested.