全人工髖關節及膝關節置換術服務量與結果之關連性探討
Ａssociation between hospital and surgeon volume with outcome in total hip and total knee replacement
Date Issued
2005
Date
2005
Author(s)
Lo, Hsien-Yi
DOI
zh-TW
Abstract
The relationship between volume and outcome has been investigated since 1970. Most of the literatures focused on the cancer surgery and highly technique- demanded surgery, and few of those talked about joint replacement. Due to aging of population and increasing payment for the joint replacement, a good outcome of the health care would achieve the effective utilization of the resources. An empirical evidence of the association between the hospital and surgeon volume and outcome in total joint replacement could give us some answers.
This study examined the relationship between the volume of total hip replacements and total knee replacements by hospitals and surgeons and the postoperative rates of death and complications (revision, dislocation, deep infection, periarticular fracture). A nation wide hospital discharge registry was used to identify patients who had an elective total hip replacement and total knee replacement between 1999 and 2001,and the follow up period included index hospitalization, 30 days postoperatively, 90 days postoperatively, 1 year postoperatively. The number of hip replacement and knee replacement performed during the study period was determined by each provider. The providers ware divided into four groups on the basis of fortieth, sixtieth and eightieth percentiles, and another way according to the slope change of the volume curve was divided into low, medium, and high volume. The real distributions of the provider volume and death or complication rate were also shown in this study.
Patients managed by the low-volume providers tended to have higher mortality rates, more complication rates during the index hospitalization and further follow up period.
Single joint replacement, bilateral joints replacement simultaneously, or separate operation during different hospitalization were compared using this large scale data. Although it had some difference,there was no static significantly.
About three –fourths patients received operation by the high volume provider, so it seemed to have natural regionalization tendency in this study. Enhancement of the training program to improve the experience of the practitioner, so that to get better outcome would be more important.
Subjects
全人工髖關節置換術
全人工膝關節置換術
醫師服務量
照護結果
total hip replacement
total knee replacement
hospital volume
surgeon volume
outcome
SDGs
Type
thesis
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