影響手術時間因素之研究‒以髖及膝關節置換手術為例

A study on factors affecting the operation time‒Take hip and knee replacement surgery as an example

陳韋欣(Wei-Hsin Chen)

指導教授 ： 黃俊哲

義守大學/醫學院/醫務管理學系/碩士(2023年)

摘要

背景：隨著人口高齡化骨關節置換手術需求逐年增加。為合理配置手術醫療資源，醫院須兼顧照護品質和控制醫療成本下提供病人手術服務。然而，過去研究指出手術時間延長與術後感染、住院天數及再入院等有關，因此預估手術時間和掌握影響手術時間相關因素將對提升手術室排程管理是格外重要。
目的：本研究主要目的包括：(1)探討影響髖關節及膝關節置換手術時間相關因素。(2)運用統計分析方法建立髖關節及膝關節置換手術時間預測模型。
方法：本研究採用回溯性橫斷式研究設計，資料來源擷取自南部某醫學中心臨床資料庫所提供的2016年1月1日至2022年6月30日期間年齡≥20歲、有接受全膝關節置換術、部分髖關節置換術或是全髖關節置換術的住院病人，而分別納入最終樣本數為2,231、752及736人次。變項包括病人因素(包含年齡、性別、身體體質指數、主要疾病及共病症)、醫師因素(包含骨科醫師年資、手術服務量、過去手術平均時間)、手術處置因素(包含麻醉方式、麻醉分類等級、屬於台灣版住院診斷關聯群)，以及手術時間。本研究使用廣義線性模式分析影響住院病人接受髖關節及膝關節置換手術時間相關因素，並檢測整體模型是否具預測能力。
結果：本研究結果顯示：(1)全膝關節置換術手術時間與病人年齡、主要疾病骨關節炎、醫師手術服務量，以及採取區域麻醉呈現顯著負相關，但與病人身體質量指數、男性、醫師過去手術平均時間呈現顯著正相關。(2)部分髖關節置換術手術時間與無共病症病人、醫師手術服務量、採取區域麻醉呈現顯著負相關，但與病人身體質量指數呈現顯著正相關。(3)全髖關節置換術手術時間與醫師手術服務量、採取區域麻醉呈現顯著負相關，但與病人身體質量指數、醫師過去手術平均時間呈現顯著正相關。(4)三項髖關節及膝關節置換手術時間相關因素之模型估計皆具有顯著預測能力。
結論：本研究發現病人身體質量指數越高，三項髖關節及膝關節置換手術時間越長。此外，醫師過去手術服務量越少和採取區域麻醉，三項髖關節及膝關節置換手術時間越短，期研究結果可作為醫院管理者和醫護人員建立髖關節及膝關節置換手術時間預測模型和協助骨科手術排程管理參考。

關鍵字

膝關節置換手術 ； 髖關節置換手術 ； 部分髖關節置換術 ； 手術時間 ； 廣義線性模式

並列摘要

Background: With the aging population, the demand for bone and joint replacement surgery is increasing year by year. To allocate surgical medical resources reasonably, hospitals must provide patients with surgical services while taking care of the quality of care and controlling medical costs. However, previous studies have pointed out that prolonged operation time is related to postoperative infection, length of hospital stay, and readmission. Therefore, predicting operation time and mastering factors affecting operation time will be particularly important for improving operating room scheduling management.
Objectives: The main purposes of this study include: (1) To explore the factors affecting the operation time of hip and knee replacement. (2) Using statistical analysis methods to establish a prediction model for hip and knee replacement operation time.
Methods: This study used a retrospective cross-sectional study design. The data resource was from the clinical database provided by a medical center in southern Taiwan. We identified inpatients aged ≥20 years and who have undergone total knee replacement (TKR), partial joint replacement-cup or hip prosthesis or unicompartmental (PJR), and total hip replacement (THR) during the period from January 1, 2016, to June 30, 2022. The final sample size included 2,231, 752, and 736, respectively. The variables included patient factors (including age, gender, body mass index (BMI), main diagnosis, and numbers of comorbidities), surgeon factors (including seniority of orthopedic surgeons, surgical volume, the average time of past operations), surgical management factors (including types of anesthesia, American Society of Anesthesiologists (ASA) classification and whether the case was reimbursed by Taiwanese Diagnosis Related Groups (TW-DRG) payment), and operation time. Generalized linear models were used to evaluate factors associated with the operation time of hip and knee replacement and to test the predictive power of the overall model.
Results: The study results showed that (1) The operation time of TKR was significantly negatively correlated with patient age, main diagnosis of osteoarthritis, surgeon's surgical volume, and the regional anesthesia, whereas was significantly negatively correlated with the patient’s BMI, male gender, and the surgeon's average time of past operations. (2) The operation time of PJR was significantly negatively correlated with patients without comorbidities, surgeon's surgical volume, and regional anesthesia, whereas was significantly positively correlated with the patient’s BMI. (3) The THR operation time was significantly negatively correlated with the surgeon's surgical volume and regional anesthesia but was significantly positively correlated with the patient’s BMI and the surgeon's average time of past operations. (4) The model estimates of factors associated with the operation time of the three hip and knee replacements had significant predictive power.
Conclusion: This study found that for patients with increased BMI, the longer operation time of the three hip and knee replacements. Additionally, surgeons with lower surgical volume and use regional anesthesia and the operation time of the three hip and knee replacements were shorter. The results of this present study can be used as a reference for hospital administrators and medical staff to establish a prediction model for the operation time of hip and knee replacements and assist orthopedic surgery scheduling management.

並列關鍵字

total knee replacement ； total hip replacement ； partial joint replacement-cup or hip prosthesis or unicompartmental ； operation time ； generalized linear models

參考文獻

一、中文部分

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林慧娟 (2018年10月19日)。多少人才夠？談多變項分析的樣本數問題。取自 https://www.stroke.org.tw/GoWeb2/include/index.php?Page=5-1&paper02=11872991235bc96710da901

國家發展委員會 (2022)。人口推估查詢系統。高齡人口佔比趨勢。取自 https://pop-proj.ndc.gov.tw/chart.aspx?c=10&uid=66&pid=60

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