腰椎狹窄傳統與微創手術的醫療耗用與醫療品質差異分析

由於全球人口老化趨勢日益嚴重，各國逐漸走向「超高齡社會」。因此，隨著年紀增長，退化性疾病「腰管狹窄」是一種慢性退化性關節疾病，因脊椎退化而骨刺漸漸形成，直接壓迫到椎管內的神經造成行動不便，引起老人家下背痛最常發生的原因。而現今社會的醫療科技及技術日益發達，雖傳統手術雖然能解決許多的問題，但也逐漸微創手術所取代。本研究目的想了解脊椎傳統手術和微創手術在手術過程中，比較醫療品質及醫療資源耗用差異分析，作為醫療政策上的規劃與運用之參考。本研究之方法是以回溯性的方式收集資料，研究期間為2016年1月～2016年12月。研究對象為南部某區域教學醫院外科部腦神經外科就診而經確認有腰椎狹窄疾病(ICD-9 診斷碼：724.2)，分別為接受傳統手術46位與微創手術44位共90位個案。並且運用敘述性統計（百分比、標準差、頻率），推論性統計（卡方檢定、獨立樣本t檢定）來分析資料，以 SPSS for Windows 19.0 套裝軟體進行統計分析。本研究使用麻醉總時數、手術總時數與住院總日數做為代表性指標。由疾病嚴重度與醫療資源耗用的整理結果，可以知道腰椎狹窄的疾病嚴重度會影響醫療資源耗用。腰椎狹窄疾病牽涉的脊椎節數愈多，其病患的麻醉總時數、手術總時數與住院總日數就愈長。植入的人工植入物數量愈多，病患的手術總時數與住院總日數也愈長。接受不同處置之個案的各項醫療醫療資源耗用差異，接受傳統手術或微創手術患者之平均麻醉總時數及平均手術總時數皆無達到統計上顯著性得差異，但接受微創手術患者之住院總日數顯著少於接受傳統手術之患者。對於腰椎狹窄以神經外科介入性處置是非常安全的治療方式。在個案醫院裡，接受傳統減壓手術或微創手術的病患，其住院期間皆無發生不良事件，但醫療資源耗用的情況有顯著差異，即接受傳統減壓手術的病患耗用較高的醫療資源。對於醫療機構、未來學術醫療工作者提供臨床上相關建議，以減少醫療資源的浪費及提升一般民眾就醫品質。

關鍵字

脊椎手術；醫療耗用；醫療品質

並列摘要

OBJECTIVE. Part of aging process, lumbar spinal stenosis (LSS) is the most common reason for degenerative changes with the lumbar column in elderly population. Lumbar spondylosis might result in mechanical back pain of various degrees, claudicant symptoms, reduced mobility and poor quality of life. Operative intervention is considered when the severely pain is not relieved by non-operative treatment. Open surgery (OS) is the surgical approach conventionally used for lumbar stenosis. However, greater change in multifidus, greater muscle damage and functional disability in terms of post-operative complications are frequently seen. In recent years, minimally invasive (MIS) treatment for decompression has become widely practiced for achieving effective operation and reducing approach related complications. It is predictable that medical resource utilization would be impacted with the aging population. The purposes of this research were: 1) to describe the distribution of selective LSS patients receiving operative intervention of different surgical approaches (MIS vs. OS) at our institution,2) to explore the quality of care of the above-mentioned patients,and 3) to analyze the medical resource utilization of the above-mentioned patients’。 METHODS. This is a retrospective chart review within a regional teaching hospital of patients underwent operative interventions (MIS vs. OS) for LSS (ICD-9 diagnosis code: 724.2) from January to December 2016.Complications after surgery as well as immediate re-operation for any reason were defined as indicators to quality of care, in addition, anesthesia duration, operation duration, and hospital length of stay were noted to define the medical resource utilization. All these parameters were used to evaluate the differences Between MIS and OS groups. Ninety patients (44 in the MIS group and 46 in the OS group) were further reviewed to better characterize the sample. RESULTS. No patient developed any post-operative complication.No significant between group differences in terms of the average anesthesia duration and average operation duration were found. However, average length of hospital stay for the patients receiving OS was significantly higher than those who receiving MIS. CONCLUSION. Neurosurgical intervention is safe for patients with LSS.Postoperative complication rates associated with these procedures are very low in the early postoperative period. The results warrant a further study with much bigger scale to evaluate the minimally invasive procedures which might reduce the hospital stay related resource utilization.

並列關鍵字

spinal surgery ； medical resources utilization ； quality of care

參考文獻

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腰椎狹窄傳統與微創手術的醫療耗用與醫療品質差異分析

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