Outcome Analysis of Arterio-venous Fistula in Taiwan by National Health Insurance Research Database (NHIRD) 1996-2001

由台灣健保資料庫分析1996至2001年動靜脈廔管手術之存活模式

顏仲毅(Chung-Yih Yan) ； 蒲啓明(Chi-Min Pu) ； 劉致和(Charles C.H. Liu) ； 翁昭旼(Jiau-Min Wong) ； 蔣以仁(I-Jen Chiang) ； 李鐵國(Tit-Kwok Lee) ； 呂旭彥(Shiuh-Yen Lu) ； 吳瑞星(Simon Jui-Hsing Wu)

《中華民國整形外科醫學會雜誌》 13卷2期 (2004/06) Pp. 80-89

https://doi.org/10.7096/JPSA.200406.0080

摘要

本研究係針對台灣健保資料庫分析動靜脈瘻管手術之存活率。我們從1996至2000年的健保資料庫住院病患二十分之一的取樣中獲得1520例曾接受動靜脈瘻管手術之病患，追蹤其術後是否再次接受血管更新手術。我們發現在此期間動靜脈瘻管的初次存留率有81.78%至90.56%（依手術代碼定義嚴寬不同）。我們發現術後血管存活率曲線以及再手術的兩個尖峰時間曲線皆有固定模式。以時間－存活曲線分析後，動靜脈瘻管總體存活率在第一年為80%，第二年為72%，第三年為66%。我們也比較了初次病患以及非初次病患之不同，血管更新手術之比例分別為16.37%及27.71%，總體18.22%。

並列摘要

This study reports the outcome and revision history after arterio-venous fistula operations in Taiwan by case linkage in the National Health Insurance Research Database (NHIRD) from 1996 to 2000. 1520 patients with confirmed clinical details of arterio-venous fistulae were queried from the 1/20-sampled hospitalization dataset, then the subsequent revision operations were traced in the whole non-sampled database. The methodology of follow-up study in NHIRD was validated by the consistent patterns of vascular events selected by either loose or strict criteria of the ICD procedural codes.
The primary patency rate by the hospitalization data was between 90.56% and 81.78%. The overall A-V fistula patency rate is 80% in the first year, 72% in the second, and 66% in the third year. If revisions at the outpatient service were added, the revision rate would double, but the outpatient data was unreliable due to obscure ICD information. Our methodology yielded consistent shapes of survival curves and the two peaks of re-operations, the latter of which might be events after re-do shunts. Freshness of the cases could be studied by the previous vascular history in NHIRD. The revision rates are 16.37% and 27.71% for fresh and non-fresh arterio-venous fistula respectively.

並列關鍵字

arterio-venous fistula ； dialysis access ； claim database ； population-based study