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  • 學位論文

預防性抗生素臨床指引與治療結果之關係∼以闌尾切除術為例

The Relationship of Clinical Guidelines in Prophylactic Antibiotics and Treatment Results∼An Application of Appendectomy

指導教授 : 鄭守夏

摘要


目的:手術前給予適當的預防性抗生素已經證實可以降低術後傷口感染率的發生,也可以減少醫療費用。因此,本研究利用全國闌尾切除病患之資料來探討台灣醫院執行闌尾切除術使用預防性抗生素之現況及預防性抗生素使用是否符合臨床指引建議,同時再深入探討預防性抗生素使用是否符合臨床指引建議對闌尾切除術治療結果之影響。 方法:利用2003及2004年全民健保研究資料庫中住院醫療費用清單明細檔、住院醫療費用醫令清單明細檔及藥品主檔,再搭配中華民國感染症醫學會與台灣外科醫學會所公布之『台灣地區預防性抗生素臨床指引』分成四個模式—嚴格模式、放寬模式一、放寬模式二及寬鬆模式來探討闌尾切除病患預防性抗生素使用是否符合臨床指引建議。 結果:全民健保研究資料庫中2003及2004年論病例計酬之闌尾切除病患共有29,830人,其中有使用抗生素之闌尾切除病患臨床指引符合率分別為嚴格模式1.07%,放寬模式一15.68%,放寬模式二14.80%及寬鬆模式19.02%。低資歷及高服務量之醫師在放寬模式一、二及寬鬆模式中都有顯著較高的臨床指引符合率。在影響闌尾切除治療結果之因素方面,預防性抗生素使用是否符合指引建議是影響住院費用、住院天數的重要因素;而闌尾切除術後疑似傷口感染率為1.46%。 結論:本研究發現抗生素符合臨床指引是可以減少住院天數及住院費用,但是國內闌尾切除預防性抗生素的使用符合臨床指引建議仍低於20%,所以有待衛生單位加強臨床指引的推廣。

並列摘要


Objective: Using prophylactic antibiotics before surgery to prevent post-operative wound infection and reduce medical cost was widely acknowledged. The objectives of this study were: to describe the use of prophylactic antibiotics in appendectomy in Taiwan and its adherence to the clinical guidelines; and to investigate the treatment results of appendectomy associated with guideline adherences of prophylactic antibiotics. Method: This study employed data concerning inpatient expenses and medical orders from 2003 and 2004 National Health Insurance Research Database. Guidelines for the use of prophylactic antibiotics in surgery was obtained from “Infectious Diseases Society of the Republic of China” and “Taiwan Surgical Association”. This study constructed guidelines adherences into four models—Rigid model, Mild model 1, Mild model 2 and Loose model to analyze guideline adherences of prophylactic antibiotics in appendectomy. Results: The number of appendectomy due to acute appendicitis coded as ICD-9-CM 540.9 and 470 in DRG in 2003 and 2004 was 29,830 patients. The guideline adherences rates among patients receiving antibiotics were 1.07% in Rigid model, 15.68% in Mild model 1, 14.80% in Mild model 2 and 19.02% in Loose model. Patients treated by doctors with fewer practice years or higher service volume in Mild model 1, Mild model 2 and Loose model were more likely to received antibiotics adherenced to the guidelines. Guideline adherences of prophylactic antibiotics was one of the important factors that affected length of stay and medical cost. Suspected postoperative wound infection rate for appendectomy was 1.46% nationwide. Conclusion: This study showed that guideline adherences of prophylactic antibiotics might reduce length of stay and cost; however this study also found guideline adherences of prophylactic antibiotics in appendectomy was smaller than 20%. Therefore health authorities should pursue strategies to improve the guideline adherences of prophylactic antibiotics usage.

參考文獻


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被引用紀錄


許振東(2012)。遵循抗生素臨床指引與治療結果關係之研究-以肺炎治療性抗生素與手術預防性抗生素之使用為例〔博士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2012.02483

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