Department of International Business Administration, Chienkuo Technology University, Changhua City, Taiwan.
J Formos Med Assoc. 2011 Jun;110(6):401-9. doi: 10.1016/S0929-6646(11)60059-4.
BACKGROUND/PURPOSE: The impact of provider volume, comorbidity and adverse outcomes on hospital utilization of total hip arthroplasty (THA) has not yet been studied scientifically in Taiwan. This study aimed to examine the relationship between surgeon/hospital volume, perioperative complications, acute infections and hospital utilization for patients who underwent primary (THA).
We analyzed National Health Insurance (NHI) annual reimbursement data for all hospital admissions due to primary THA between January 2005 and December 2006. A total of 9335 patients with rheumatoid arthritis, osteoarthritis, avascular necrosis and other joint disorders were identified. Multivari-ate regression analyses were used to assess the relationship between provider volume and hospital utilization and the risk of adverse outcomes. Statistical analyses were adjusted for patient age, gender, comorbidity, type of arthritis, as well as hospital attributes.
Reversed linear associations were found among hospital utilization, surgeon volume, and comorbidity score. Patients with acute infection tended to stay 8 days more and cost NT$32,451 more than their counterparts. Patients with perioperative complication tended to stay 2.30 days more and cost NT$15,327 more than their counterparts. Longer hospital stay and higher total hospital charge were associated with patient's age and Charlson index.
This study revealed that the volume of THAs performed by individual surgeons was a more important determinant of hospital utilization than hospital volume. Perioperative adverse events were associated with patients' age and comorbidity.
背景/目的：在台湾，尚未有科学研究探讨医生/医院手术量、合并症和不良结局对全髋关节置换术（THA）医院利用的影响。本研究旨在检验术者/医院手术量、围手术期并发症、急性感染与初次 THA 患者医院利用之间的关系。
我们分析了 2005 年 1 月至 2006 年 12 月所有初次 THA 住院的全民健康保险年度报销数据。共确定了 9335 例患有类风湿关节炎、骨关节炎、股骨头坏死和其他关节疾病的患者。采用多变量回归分析评估术者/医院手术量与医院利用和不良结局风险之间的关系。统计分析调整了患者年龄、性别、合并症、关节炎类型以及医院属性。
医院利用、术者手术量和合并症评分之间呈反向线性关联。发生急性感染的患者住院时间延长 8 天，费用增加新台币 32451 元。发生围手术期并发症的患者住院时间延长 2.30 天，费用增加新台币 15327 元。住院时间延长和总住院费用增加与患者年龄和 Charlson 指数有关。
本研究表明，单个术者进行的 THA 数量是影响医院利用的更重要因素，而不是医院手术量。围手术期不良事件与患者年龄和合并症有关。
