探討良性攝護腺增生病人採不同術式後的併發症與術前合併症之關聯

The association between complications after the adoption of different operations and preoperative comorbidities for benign prostate hyperplasia patients

盧致誠(Chih-Cheng Lu) ； 陸言(Yan Lu) ； 袁得峻(Te-Chun Yuan)

《醫療資訊雜誌》 26卷2期 (2017/06) Pp. 1-15+17-20+22

摘要

良性攝護腺增生(Benign prostatic hyperplasia, BPH)是一種老年人常見的疾病，隨著國人平均餘命與老年人口迅速增加，老年人的醫療需求與生活品質逐漸受到重視，BPH患病後不但影響病人生活品質，高發生率也對醫療資源造成影響。而目前醫病之間的認知存在差距，若能縮小病人在BPH術式上認知差距並在治療方式上取得共識，及時告知病人治療的利弊及可能面臨的風險與後果，澄清不切實際的期待與決定，再進一步說明可供選擇或替代的方案作為參與醫療決策的基礎，就能提升醫病雙方決策後的滿意度及病人參與醫療決策的動機與自信。研究資料來源為國家衛生研究院發行之2010年健保資料庫承保抽樣歸人檔，使用就醫資料檔案為「門診處方及治療明細檔」、「住院醫療費用清單明細檔」、「住院醫療費用醫令清單明細檔」，為求研究對象一致性，本研究資料收集從2005年至2010年區間的BPH病人，排除非手術治療的病人後，選取2006年～2008年間首度採取BPH較常使用之術式刮除手術與切開手術治療的病人為研究對象，再利用健保資料庫檔案間相互共通欄位將病人就醫資料檔案串聯後，依術式類型將選取的病人區分，再分別選取二種術式病人之術後二年併發症與術前一年合併症，經資科清洗整理後，採用Weka3.6.6版本做為本研究資料探勘工具，再應用關聯規則中Apriori技術進行資料探勘與資料處理分析。研究樣本共有540人，研究結果發現：二種術式病人年齡主要分佈在61-80歲區間，而60歲以下的病人大多使用切開手術，手術病人多數患有一個以上的合併疾病，術前除泌尿道相關疾病外心臟病與高血壓疾病有較高機率伴隨BPH出現，術後最常見併發症為泌尿道感染。

關鍵字

良性攝護腺增生 ； 健保資料庫 ； 資料探勘 ； Apriori

並列摘要

Benign prostate hyperplasia, also called benign prostatic hyperplasia (BPH), is a common disease among elderly people. With increase in the average life expectancies and with the growing populations of elderly people in various countries, healthcare to maintain quality of life for the elderly is becoming gradually more valuable. BPH not only affects quality of life; its recurrence can significantly affect the availability of medical resources. Currently, knowledge gaps often exist between patients and healthcare professionals. Patient satisfaction can be enhanced after a decision is made by both parties, and patient levels of motivation and self-confidence can be enhanced through involvement in medical decision-making if the gaps in patients' knowledge on BPH surgery are reduced and a mutual consensus on treatment is reached. Coupled with patients being promptly informed of the benefits, drawbacks, potential risks, and consequences of treatment, reaching such a consensus helps prevent unrealistic expectations and decisions. In other words, further explanation of alternative treatment options by medical professionals can serve as a base for patient participation in medical decision-making. The research sources for this study were the 2010 Longitudinal Health Insurance Database, which is a subset of the National Health Insurance Research Database issued by the National Institutes of Health, from which the National Health Insurance (NHl) ambulatory files (e.g., data on ambulatory care expenditure per visit, inpatient expenditure per admissions, and details of inpatient orders) were used. For sample consistency, BPH patient data from 2005 to 2010 were collected, excluding patients who had undergone nonsurgical treatment. Participants who had undergone curettage surgery or incision surgery to treat BPH between 2006 and 2008 were selected. In addition, data fields from claims data were merged with data files of the basic characteristics of the patients. Complications occurring within 2 years of the postoperative treatment and comorbidities occurring within 1 year before preoperative treatment were selected separately. After data cleansing, Weka3.6.6 version was used as a data mining tool. Subsequently, the association rules were applied to Apriori techniques for data processing and analysis. In total, 540 people were enrolled. The research findings were as follows: Patients who had undergone one of the two operation types were aged 61-80 years, whereas patients under 60 had mostly undergone incision surgery. The majority sufferred from more than one comorbidity; for example, in addition to BPH-related urinary tract disease, higher percentages of heart disease and high blood pressure occurred after the diagnosis of BPH, whereas the most common postsurgical complication was urinary tract infections.

並列關鍵字

Benign prostate hyperplasia ； National Health Insurance Research Database ； Data Mining ； Apriori