衰弱對髖部骨折病患醫療資源使用和術後健康生活品質之影響

The Impact of Frailty on Medical Utilization and Postoperative Health-Related Quality of Life in Surgical Hip Fracture Patients

黃琇棠(Siou-Tang Huang)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士班/碩士(2018年)

摘要

研究目的
隨著台灣高齡社會的演進，衰弱與髖部骨折已是不可忽視的議題，除了降低長者的生活功能外，更可能影響生活品質。因此本研究欲瞭解衰弱程度對於髖部骨折病患療效（當次術後、短中期）與醫療資源使用及術後生活品質之影響。
研究方法
本研究採前瞻且縱貫性設計，收案時間為2016年1月至2017年4月止，研究範圍為南部四間醫院，樣本為初次診斷髖部骨折病患共302人。資料包含生活品質問卷、病歷審查和住院醫療費用檔案。統計工具為 STATA 13.0、 SPSS 20.0。
研究結果
本研究共分為兩個架構，在架構一當次併發症中以手術方式ORIF風險最高(OR=5.17)；在超長住院中以有無輸血影響最多(OR=3.20)；執行ORIF術式的病患(ref=CRIF)住院天數增加2.07天，HA的病患(ref=CRIF)醫療總費用高出34,388元；合併症CCI≧3分病患(ref=0分)有12倍風險發生三個月再入院，有合併帕金森氏症(ref=未合併)有5.21倍風險發生三個月再急診，最後＞85歲病患(ref≦75歲)一年內死亡風險高出16.23倍。架構二中健康生活品質改善幅度不論是EQ-5D和Utility score做為指標，皆是Robust組恢復情況最好。在術後三個月至六個月Frail組(ref=Robust)生活品質(EQ-5D)分數減少2.86-1.96分，Frail組效用分數(Utility score)分數減少0.09-0.18分。
結論
架構一與假說不符，主要原因可能與骨科相關手術納入Tw-DRGs有關。架構二中生活品質短中期Robust組恢復情況最好，影響因子包含：衰弱程度、年齡、合併帕金森氏症，此部分與多數文獻皆呈相同結果。

關鍵字

衰弱 ； 髖部骨折 ； 術後療效 ； 醫療資源使用 ； 健康生活品質

並列摘要

Background
With an aged society, frailty and hip fractures are consequences that cannot be ignored in Taiwan. In addition to reducing the physical function of the elderly, it also affects their quality of life. Therefore, this study aims to explain the effect of the degree of weakness on hip fractures patients (postoperative, short-term) and the impact of the use of medical resources and postoperative health-related quality of life.
Method
The study adopted a prospective and longitudinal design, subjects were 302 people in initial diagnosis of hip fracture patients admitted to four hospitals in the south, from January 2016 to April 2017. The data were derived from quality of life questionnaires, the chart review, and medical utilization obtained from inpatient expenditures by admissions. All statistical analyses were conducted using STATA software, version 11.0 (StataCorp LP, College Station, TX) and SPSS software, version 20.0 (SPSS Inc., Chicago, Illinois).
Results
The study was divided into two parts, 302 patients underwent the study period in total. The clinical outcome showed that surgery type in ORIF was a more significant and stronger predictor for postoperative complication (OR, 5.17), and blood transfusion was also a predictor for prolonged stay (OR, 3.20). The medical utilization showed that the length of stay for surgery type in ORIF patients was more than 2.07 days on average and the health expenditures for surgery type in HA patients costed more than 34,388 dollars during hospitalization. The follow-up clinical outcome revealed that the number of patients with CCI≧3 was 12 times higher than patients with CCI=0 for readmissions in three months, and the number of patients with Parkinson's disease was 5.21 times higher than that of non-Parkinson's disease returning to the emergency department in three months. The number of patients aged more than 85 years old was 16.23 times higher than that of patients aged less than or equal to 75 years old (according to the amount of mortalities in one year). The Robust group restored the best in health-related quality of life (EQ-5D and utility score). The mean of the EQ-5D with frail decreased 2.86-1.96 and the mean of the utility score with frail decreased 0.09-0.18 between 3 months and 6 months.
Conclusions
The main reason the hypothesis was refuted may be associated with the orthopedic operations including Tw-DRGs payment system in part one. The Robust group restored the best in health-related quality of life of short and middle term in part two, the predictors include frailty level, age, and patients with Parkinson's disease. It’s the same result as most research papers.

並列關鍵字

Frailty ； Hip Fracture ； Medical Utilization ； Health-Related Quality of Life

參考文獻

英文文獻

1.Abrahamsen, B., van Staa, T., Ariely, R., Olson, M., & Cooper, C. (2009). Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int, 20(10), 1633-1650.

2.Alencar, M. A., Dias, J. M., Figueiredo, L. C., & Dias, R. C. (2013). Frailty and cognitive impairment among community-dwelling elderly. Arq Neuropsiquiatr, 71(6), 362-367.

3.Bagshaw, S. M., Stelfox, H. T., Johnson, J. A., McDermid, R. C., Rolfson, D. B., Tsuyuki, R. T., . . . Majumdar, S. R. (2015). Long-term association between frailty and health-related quality of life among survivors of critical illness: a prospective multicenter cohort study. Crit Care Med, 43(5), 973-982.

4.Bellamy, J. L., Runner, R. P., Vu, C. C. L., Schenker, M. L., Bradbury, T. L., & Roberson, J. R. (2017). Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Hip Arthroplasty. J Arthroplasty, 32(10), 2963-2968.