Epidemiology and Medical Costs of Patients with Hip Fracture at a Medical Center in Central Taiwan

髖骨骨折之流行病學及醫療支出－以中台灣某醫學中心爲例

黃昭偉(Chiu-Wai Wong) ； 葉兆斌(Chao-Bin Yeh) ； 周明智(Ming-Chih Chou) ； 張慧瑾(Hui-Chin Chang)

《Journal of Emergency Medicine, Taiwan》 10卷3期 (2008/09) Pp. 81-86

摘要

目的：髖骨骨折常見於世界各地的老年齡層，且是致死的主因之一。在亞洲，髖骨骨折的類型與醫療支出相關實證資料卻相當稀少。本研究主要針對各老年齡層與髖骨骨折型態比較及不同年齡層的骨折醫療支出。
方法：這是一項回溯性的研究，樣本為六十五歲及以上因跌倒造成髖骨骨折，且在2006年1月至2006年12月到中部某醫學中心就診的患者，分析內容包含：年齡、性別、季節氣候、骨折型態、住院時間及醫療費用等。
結果：有效樣本數為107人，囊內及囊外骨折平均年齡78.2±7.7歲及81.1±7.6歲，51.1% (60 of 107)為囊內骨折及43.9% (47 of 107)為囊外骨折，95人接受手術，12人因並存嚴重疾病而延遲或拒絕手術。平均住院天數13天，每位病人平均醫療費為NT$97289。
結論：髖骨骨折疾病沈重地打擊著台灣的醫療健保體制。此一疾病以囊外骨折及年長女性最多。季節與骨折並無任何意義且在本研究與其他研究比較下，髖骨骨折病患住院天數較短。而75-84歲年齡層老年人發生髖骨骨折次數最多且住院天數最長。本研究強調髖骨骨折醫療支出引起的社會經濟衝擊，主要與住院時間有明顯對應關。

關鍵字

髖骨骨折 ； 囊外骨折 ； 囊內骨折 ； 住院天數 ； 醫療支出

並列摘要

Objective: Hip fracture (HF) is a major cause of morbidity and mortality in the elderly worldwide. Little information is available about the types of hip fracture and medical expenditures in Asia. This study analyzed the types of HF in different age groups over 65 years, outcomes and hospital costs.
Methods: This was a retrospective study of patients over 65 years old who had hip fractures after falls or trauma and visited a medical center in central Taiwan between January and December 2006. Age, gender, season of the year, fracture types, duration of hospitalization, and medical expenditures were recorded.
Results: A total of 107 qualified patients were included in this study. The mean ages of patients with intracapsular and extracapsular types of hip fracture were 78.2±7.7 years and 81.1±7.6 years, respectively. Sixty out of 107 patients (56.1%) presented with extracapsular fractures and the others presented with intracapsular fracture. Ninety-five patients (88.8%) received surgery. Twelve patients did not receive surgery because of severe co-morbidity or because they declined the procedure. The mean hospital stay was 13 days. The mean hospital expenditure was NT$97, 289.
Conclusion: Extracapsular fracture was the more common type in older women. But there was no seasonal variability and the length of hospital stay was shorter compared to other studies. Hip fractures occurred more frequently and hospitalization was longer in the 75-84 year age group than the other age groups. These results emphasize the growing economic impact arising from inpatient treatment of hip fractures, mostly related to the length of hospital stay.

並列關鍵字

hip fracture ； extracapsular type ； intracapsular type ； hospitalization stay ； hospital costs