提供者服務量與膀胱癌病患進行膀胱根除術之結果分析

Role of Surgeon Volume and Hospital Volume in Radical Cystectomy Outcomes of Bladder Cancer Patients

劉嘉年(Chia-Nien Liu)

《台灣公共衛生雜誌》 28卷3期 (2009/06) Pp. 184-193

https://doi.org/10.6288/TJPH2009-28-03-03

摘要

目標：針對罹患膀胱癌且進行膀胱根除術的病患，以多層級模式分析其醫師、醫院手術量與手術結果的關係。方法：採次級資料分析法，資料來源為全民健保學術研究資料庫。研究對象為2002~2005年間因膀胱癌(ICD-9-CM code188，236.7)住院，同時接受膀胱根除術(ICD-9-CM，code 57.7)者為對象。在提供者服務量變項方面，醫師分成高、中、低手術量三組，醫院分成高、低手術量兩組。結果變項以手術短期結果為主，包含住院死亡率、併發症、與超長住院。本研究以多層級模式處理階層性資料，以減少群集效應。結果：2002~2005年間罹患膀胱癌且接受膀胱切除術病患有1,045人，院內死亡者有21人(2.01%)，住院期間發生手術併發症者有129人(12.34%)，住院超過30日者235人(22.49%)。在控制影響因素之後，發現醫師手術量越高的分組，其住院死亡率、併發症比率與超長住院比率越低；而醫院手術量則與住院死亡率、併發症、以及超長住院無關。結論：醫師手術量越高者其手術結果較佳，醫師手術量比醫院手術量對結果更具影響力。

關鍵字

結果 ； 醫師服務量 ； 醫院服務量 ； 膀胱根除術 ； 多層級模式

並列摘要

Objectives: This study used a multilevel model to analyze the relationship between procedure volume and radical cystectomy outcomes of bladder cancer patients. Methods: We conducted a secondary data analysis study of the association between annual cystectomy volumes and outcome indicators. A total of 1,045 patients from 2002 to 2005, diagnosed with bladder cancer (ICD-9-CM codes 188, 236.7) and treated with radical cystectomy (ICD-9-CM code 57.7) were selected from the database of ”Inpatient Expenditures by Admissions” provided by the Bureau of National Health Insurance (BNHI). To obtain physician and hospital information, we linked the inpatient records of the research samples with the databases of ”registry for medical personnel” and ”registry for contracted medical institutions.” Outcome indicators were in-hospital mortality, complication rate, and prolonged length-of-stay (over 30 days). Multilevel logistic regression was used to adjust factors for different nested levels of patients and physicians. Results: The in-hospital mortality rate, overall complication rate, and prolonged length-of-stay in our study were 2.01%, 12.34%, 22.49%, respectively. After controlling for other factors, physicians with higher cystectomy volumes had significantly better outcomes, including lower in-hospital mortality, lower complication rate, and shorter lengths-of-stay, than physicians with lower procedure volumes. Hospital volumes had no significant relationship with outcomes indicators. Conclusions: Better outcomes in bladder cancer patients with cystectomy occurred when surgeons had high procedure volumes. Surgeon volumes had a greater effect on outcomes than hospital volumes.

並列關鍵字

Outcomes ； Surgeon volume ； Hospital volume ； Radical cystectomy ； Multilevel model Analysis

參考文獻

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