- 學位論文
探討傳統融合與動態脊椎非融合手術醫療資源耗用與療效之研究
To compare medical resources utilization and outcomes between traditional fusion and dynamic spine non-fusion surgeries
摘要
研究目的 腰椎融合術是個很常見的手術，長期追蹤後有些病患會出現鄰近節段退化性疾病及其他相關合併症，醫療耗用花費多，近來發展出新的非融合手術，腰椎棘突間支架置入，目前國內尚未納入健保給付，因此，本研究以探討傳統融合手術及動態非融合穩定手術分析影響手術醫療療效及醫療資源耗用的相關因素。 研究方法 本研究採用回溯性研究分析，資料來源採取自台灣南部某家醫院，以病歷回溯方式取得腰椎手術個案，收集 2015-2017年腰椎手術個案為對象。將資料依傳統腰椎融合手術及動態非融合穩定手術分為兩組，共收集148位個案，探討病患人口學特性、臨床特性及手術處置後醫療療效及醫療資源耗用的影響， 採用SPSS 22.0進行資料處理分析，利用卡方檢定及獨立樣本T檢定等統計方式描述各個變項及分析兩種手術方式的差異。 研究結果 本研究樣本進行PSM配對後共148人，融合與非融合手術女性(46)人皆多於男性(28)人，BMI指數平均值在25.8 ± 3.4，無抽菸人數高於有抽菸的人數，在人口學及臨床特性有顯著性差異(P < 0.05)。在醫療資源耗用上，融合手術比非融合動態穩定手術有較高的醫療花費(P < 0.001)，且融合手術比非融合動態穩定手術在住院天數、出血量上也有顯著差異(P < 0.001)，在醫療療效資源耗用及醫療療效，非融合動態穩定手術都有比較好的結果，但在門診次數、手術後併發症、再次入院皆無顯著差異。 結論與建議 傳統腰椎融合手術的患者在住院時間、手術時間及出血量皆高於動態非融合腰椎手術，儘管動態非融合手術在植入物費用就高於傳統植入物費用，但醫療總成本費用仍高於動態非融合腰椎手術，平均總醫療費用相差63,015元，脊椎手術精密度高、植入物昂貴不斷更新、手術技巧養成耗費，在不同層級醫院帶來結果可能也因為成本不同而有所差別，因此仍須將研究擴展比較不同層級醫院，數據更加實際面，將此研究提供醫療管理者及健保局變更DRG制度時作為參考，達到兼顧醫療品質並節省資源耗用，使病患及家屬能獲得充分的資訊。
並列摘要
Purpose: Lumbar vertebra fusion was a common surgery, and traditional fusion surgery requires more destruction of the structure. After long-term tracing that a part of patients may had degenerative diseases at adjacent segments or related complications, and medical expenditures are expensive. Recently, a new fusion surgery has been developed which was Lumbar spine interstitial stent placement, but not included in the health insurance payment in Taiwan yet. Therefore, this study purposed to investigate the impact of traditional fusion surgery and dynamic non-fusion stable surgery on the impact of surgical medical treatment and medical resource consumption. Methods: In this study, we used retrospective analysis, which all the data source was taken from an inpatient medical database in a southern hospital in Taiwan. According to the lumbar spine surgery were divided into two groups 1) traditional lumbar fusion surgery and 2) dynamic non-fusion stabilization surgery, which collected the total 148 case from the 2015-2017 year. In this study, to investigate the demographic characteristics, clinical characteristics, postoperative medical treatment efficacy, and medical resource consumption, we performed the data used by SPSS 22.0 for data processing and analysis were performed, and various variables were described using statistical methods such as Chi-square test and independent sample T-test, and the differences between the two surgical methods were analyzed. Results: In this study, 148 patients were matched with PSM. The female of fusion and non-fusion surgery (46) was higher than that of male (28). And, the average BMI index was 25.8±3.4, the number of non-smokers was higher than that of smokers. Results showed that demographics and clinical characteristics (P < 0.05) was a significant difference. In terms of medical resource consumption, the cost of fusion surgery was higher than non-fusion dynamic stabilization surgery (P < 0.001), and moreover, fusion surgery was significantly different from non-fusion dynamic stabilization surgery in hospital days and bleeding volume (P < 0.001). Finally, in the medical efficacy resource consumption and medical efficacy with the good result of non-fusion dynamic stabilization surgery, but there is no significant difference in the number of outpatients, postoperative complications, and re-admission. Conclusions and Suggestions： According to these results showed that, compared with dynamic nonfusion lumbar surgery, patients of traditional lumbar fusion surgery had the longer in hospital stay, operative time and hemorrhage. Even though the cost of implants in dynamic non-fusion surgery is higher than that of traditional implants, the total cost of the different medical expenses averages in traditional lumbar fusion surgery is still high about 63,015 yuan than dynamic non-fusion surgery. Because of the higher the precision of spine surgery, the implants are expensive and constantly updated, and the surgical skills training costs, which that bring results may also be different because of the different costs in different levels of hospitals, therefore, it is still necessary to expand the study to compare different levels of hospitals, thus realistic the data. This study provides a reference for medical administrators and the Bureau of Health Insurance when it changes the DRG system to achieve a balance between medical quality and resource consumption so that patients and their families can get full information.