自發性腦出血病患接受腦部手術的療效及醫療資源使用

Outcome and medical utilization of spontaneous intracerebral hemorrhage patients after brain surgery

張峻瑋(Chun-Wei Chang)

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在職專班/碩士(2015年)

https://doi.org/10.6832/KMU.2015.00151

摘要

研究目的
自發性腦出血是引起台灣中壯年及老年人死亡和殘障的重要原因之一，並且會對病人及其家庭和社會造成嚴重的衝擊。1992年統計資料指出，台灣35歲以上民眾每10萬人每年約有73人會發生自發性腦出血，而腦出血病人一個月內的死亡率高達26-30%。本研究的主要目的是探討自發性腦內出血病患接受腦部手術後的療效及醫療資源使用，並進一步研究各項影響病人預後及醫療資源使用的因素。
研究方法
本研究為橫斷性的次級資料分析，利用1996到2009年全民健保資料庫的資料，分析其中患有自發性腦出血（ICD-9:431）並接受腦部手術（OP code:01.39）19,321人之住院就醫紀錄。以SPSS 20.0版統計軟體，利用卡方、獨立樣本T檢定、對數及線性迴歸分析和存活分析等統計方法進行資料分析及驗證假說。
研究結果
台灣自發性腦出血發生率是每十萬人有44.76人，其中超過45歲的民眾腦出血發生率逐年下降，但是年齡小於45歲的年輕型中風病患發生率卻逐年上升。腦出血病患接受腦部手術的比例是13.7%，當次住院手術死亡率是24.5%，手術後住院併發症發生率是42.7%。平均住院天數27.2天，平均醫療總費用是316,142元，14天和30天再入院率分別為28.2%和35.3%(與腦出血相關則分別為12.8%和13.7%)。一年內死亡率為30.6%。高服務量醫院有較低當次住院死亡率（OR=0.60，95%CI=0.51~0.70，P<0.001）以及14天、30天再入院率。在醫學中心接受手術治療的病患其住院天數及醫療總費用較區域醫院和地區醫院高。
結論
自發性腦出血病患，在高服務量醫院接受手術治療，會有較低的當次住院死亡率、14天、30天再入院率以及較高的照護併發症發生率、當次住院天數和住院醫療總費用。男性、年齡越大、低社經地位和CCI分數1分以上，都會增加病患腦出血手術後一年內的死亡率與醫療資源使用。本研究結果，可以讓醫療主管機關作為參考，以改善腦出血手術病患的醫療品質並降低醫療資源使用。

關鍵字

自發性腦出血 ； 腦部手術 ； 併發症 ； 再入院率

並列摘要

Objectives:
Spontaneous intracerebral hemorrhage (SICH) is an important etiology to cause mortality and morbidity in elders. It can not only hurts the patients, but also affects their families and even the whole society. According to the data from 1992, in Taiwan, there are 73 persons have spontaneous ICH in erery 100,000 people and mortality rate in one month after ICH is as high as 26~30%. The purpose of this study is to analysis the outcome and medical utilization of patients with ICH after brain surgery and further find the factors that affect the prognosis and medical utilization of the patients.

Methods:
This study is a second database analysis. We analysis the data of 19,321 patients who have ICH (ICD-9:431) and brain surgery (OP code:01.39) from 1996~2009 in database of National Health Insurance Administration. Analytical method including two-sample t-test, chi-square test, logistic regression, generalized estimating equations, Kaplan-Meier analysis, cox proportional hazards model.We used statistical tool SPSS 20.0.

Results:
The incidence of spontaneous ICH in Taiwan is 44.76 in every 100,000 people which incidence rate decreases in people who older than 45 years old but increase in people who younger than 45 years old. The operation rate of people who have ICH is 13.7% ; mortality after brain surery is 24.5% and complication rate after surgery is 42.7% ; average length of stay(LOS) is 27.2 days, and average total hospital cost is NT316,142 ; 14-day and 30-day re-admission rate are 28.2% and 35.3%, separately. (ICH-related re-admisison rate are 12.8% and 13.7%). One year mortality rate is 30.6%. High-volume hospitals have lower in-patients mortality (OR=0.60, 95%CI=0.51~0.70, P<0.001) and 14-day, 30-day re-admisison rate. Total cost and length of stay of ICH patients with brain surgery in medical center are high then distrinct and local hospital.

Conclusion:
The patients than have ICH and brain surgery will have lower inpatient mortality, 14-day, 30-day re-admission and higer hospital complication, lengh of hospital stay and cost in high-volume hospitals.
Male, elder, low socioeconomic status and CCI point more than 1 will have higher one year mortality and cost after brain surgery. The results of this study can be a reference for Ministry of health and welfare to make a better policy for spontaneous intracerebral hemorrhage.

並列關鍵字

spontaneous intracerebral hemorrhage ； brain surgery ； complication ； re-admission rate

參考文獻

英文部分：

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