傳統與腹腔鏡脾臟手術之成本結果分析

曾素美

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傳統與腹腔鏡脾臟手術之成本結果分析

Cost and Outcome Analysis Between Conventional and Laparoscopic Splenectomy

曾素美 , Masters　　Advisor：張文英　　

繁體中文

脾臟手術、腹腔鏡手術、成本結果分析； Splenectomy ； laparoscopic splenectomy ； cost and outcome analysis

Abstract │ Reference (21) │ Altmetrics

Abstract 〈TOP〉

隨著醫療科技的進步，微小創傷或稱最小傷害的手術如腹腔鏡手術已因應而生，且有愈來愈普遍的趨勢。腹腔鏡式脾臟切除手術因可減少出血量及降低住院天數，所以在國外已廣泛被使用，但目前國內有關此手術之成本評估卻匱乏，所以本研究的目的旨在比較經傳統式與腹腔鏡式兩種不同手術之成本結果差異，以作為未來醫療政策給付之參考。 本研究設計為兩組回溯性個案控制研究，以病歷回溯方式，收集某醫學中心自2000年6月至2004年4月因血液科疾病須接受脾臟切除手術之病患成本與結果資料。成本部份包括病房費、診斷費、治療費、手術麻醉費、藥劑費、特殊材料費等，而結果則包括住院天數、手術時間、手術出血量、手術後合併症、手術出院後再住院率等。成本項目的資料來源為研究機構之全民健康保險申請住院醫療費用。統計方法以SPSS/Windows 10.0版中文套裝軟體進行資料分析。統計方法包括描述性統計方法（包括百分比、平均值、標準差），以了解脾臟切除手術病患的基本屬性。另以chi-square test、 independent t-test進行兩組成本與結果之比較。 本研究共收集58位脾臟切除手術病患的資料，其中30位病患為傳統式脾臟切除手術，28位為腹腔鏡脾臟切除手術。傳統式脾臟切除手術個案中，以女性居多（n=21；70%），年齡以21歲以下居多（n=16；53.3%），平均年齡為29.2歲，教育程度以國中以下居多（n=17；56.7%），婚姻以已婚未婚佔各半（n=15；50%），有27位（90.0%）無任何慢性疾病。而腹腔鏡脾臟切除手術個案中，亦以女性居多（n=24；85.7%），年齡以21至40歲居多（n=21；46.4%），平均年齡31.5歲，教育程度以高中以上佔居多（n=19；67.8%），婚姻以已婚居多（n=18；64.3%），所有病患皆無任何慢性疾病。 在成本方面，兩組平均住院醫療總費用，腹腔鏡式手術（34,122.1元）略高於傳統式手術（31,057.8元），但未達統計上之顯著差異（p =.077）。在結果方面，腹腔鏡式手術者的住院天數、手術出血量均高於傳統式手術者，但未達統計上之顯著差異（p >.05）；唯腹腔鏡手術的手術時間較長，且達統計上之顯著差異(p =.0001)。但兩組病患於手術後皆未發生任何合併症，與再住院的情形。 本研究結果發現，兩種手術方式除在手術時間有些微差異外，其於均無差異，表示兩種手術對於血液科疾病須接受脾臟手術切除之病患而言都是可行的。因此本研究結果可作為未來須脾臟手術切除的病患另一選擇與決策者在健保支付制度修改時之參考。

Parallel Abstract 〈TOP〉

With the improvement in medical science and technology, minimal invasive or so call the smallest injury of the surgery, such as laparoscopic surgery has developed and accepted widely because this surgery for spleen excision can reduce blood loss during operative period and length of hospital stay. However, few cost and outcome analytic studies could be found related to laparoscopic surgery. Therefore, the purposes of this study were to compare cost and outcome differences between traditional splenectomy and laparoscopic splenectomy. The design was retrospective case control study. Review of medical charts was used to collect data from subjects who need splenectomy from June 2000 to April 2004 in a medical center of northern Taiwan. Cost items included costs of hospitalization, diagnosis, treatment, anaesthesia, medicine, and special materials. Outcomes were measured by length of hospital stay, times for operation, blood loss, and complications and hospital readmission after surgery. The sources of costs were from the health insurance reimbursement at study hospital by the Bureau of National Health Insurance. Data were analyzed by the statistical packages, SPSS/Windows Version 11.0 in Chinese. Descriptive statistics such as percent, mean, and standard deviation were used to understand subject’s demographics. The comparative statistics such as Chi-square test and independent sample t test were used to examine the difference between two types of surgery. Fifty-eight medical charts were reviewed in this study, 30 patients received traditional splenectomy and 28 patients for laparoscopic splenectomy. Among the traditional splenectomy group, the majority of subjects were women (n=21; 70%), under age of 21 (n=16; 53.3%) with mean age of 29.2years, junior high school (n=17; 56.7%), and single and married were equal (n=15; 50%). About 27patients 90.0%）had not any chronic diseases.In contrast, in the laparoscopic splenectomy group, the majority of patients were women (n=24; 85.7%), age between 21to 40 years of old (n=21; 46.4%) with mean age of 31.5years, above high school graduates (n=19; 67.8%) and married (n=18; 64.3%). However, no one has any chronic diseases. Although the total costs of laparoscopic splenectomy (NTD$34,122.1) was slightly higher than traditional splenectomy (NTD$31,057.8), no significant difference was found (p=0.077). For the outcomes, patients who received laparoscopic splenectomy had longer length of hospital stay and larger volume of blood loss than those of traditional splenectomy; however, no significant difference was found.(p>.05). Only the laparoscopic splenectomy group has significantly longer operation time than the traditional splenectomy group (p=.0001). For both groups, there were no any complications or readmission occurred after surgery. The findings of this study demonstrate that although there is a slightly difference in operational time, both types of surgery are equal and can be used for patients who need splenectomy. Therefore, the results can be an alternative choice for any one who need splenectomy and provide information to decision-makers for future revision of health payment system.

Reference ( 21 ) 〈TOP〉

邱艷芬(1990) ．手術室護理．台北:文軒。邱文達、林曉蕾(2001)．醫療品質的新發展．新臺北護理期刊3(2)，1-6。
連結：
陳志明、陳穆寬、張正權(2003)．以內視鏡輔助之微創性甲狀腺切除術治療甲狀腺腫瘤．臺灣耳鼻喉頭頸外科雜誌38(3)．95-100。
連結：
張文英、蕭淑代(2000)。經濟成本分析的臨床應用．新臺北護理期刊2(2)，1-3。
連結：
蔡明翰、陳耀昌 (1996)。脾臟:非典型慢性骨髓增生性疾病．當代醫學 26(3)，60-61。
連結：
英文部份 Bellantone, R., Lombardi,C P., Raffaelli, M., Rubino ,F.,Boscherini, M.,& Perilli,W.(1999). Minimally invasive, totally gasless video-assisted thyroid lobectomy. The American of Surgery 177(4), 342-343.
連結：

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