| Abstract: | 背景：脊椎病變已是全民健康保險醫療費用支出前二十大疾病之一，了解傳統脊椎手術及微創性脊椎手術的醫療品質與醫療資源耗用，找出其關聯性為何，是值得探討的問題。研究目的：探討接受「傳統」脊椎手術與「微創」脊椎手術的患者，其人口學特徵、醫療品質與醫療資源耗用之差異性，及醫療品質與醫療資源耗用之關聯性。 研究方法：本研究係回溯性收集中部地區某教學醫院於2018年1月至2019年12月二年間因脊椎疾患進行傳統脊椎手術或微創脊椎手術之病患之病歷資料、醫療費用及健保申報資料等資料，包括脊椎手術類型、手術中失血量、有無併發症產生、住院天數等醫療耗用情形。所使用的統計方法則包括人數、百分比、平均值、標準差、卡方檢定、獨立樣本t檢定、皮爾森相關及迴歸分析。結果：脊椎手術以女性患者及年齡大於64歲以上者為多；微創脊椎手術的病患在醫療品質之術中失血量、術中輸血、術後併發症、手術時間及麻醉時間皆較少，在醫療資源耗用中之住院天數、住院醫療成本及健保申報點數亦較低；兩者不同之之脊椎手術其失血量、術後併發症與住院天數及健保申報點數具關聯性。 結論：微創脊椎手術在醫療品質中之失血量、術中輸血、術後併發症、手術時間及麻醉時間皆較少，同時在醫療資源耗用中之住院天數、住院醫療成本及健保申報金額皆較低，若經濟能力許可或有其他商業保險可支付自費費用之病患，建議優先選擇微創脊椎手術。
Background: Spine lesions have been included in the top 20 diseases with the largest expenditure of the medical expenses paid by the National Health Insurance. It is worth to understand the medical care quality and medical resource utilization in traditional and minimally invasive spinal surgeries.Research purposes: To explore the differences in the demographics, medical care quality, and medical resources utilization, and the correlation between medical care quality and medical resources utilization between patients undergone traditional spinal surgery and minimally invasive spinal surgery. Research methods: This study retrospectively collected data on medical records, medical costs, and NHI payment fees of patients who underwent traditional or minimally invasive spine surgery due to spinal disorders in a regional teaching hospital in Central Taiwan from January 2018 to December 2019. Data included the type of spinal surgery, blood loss during the operation, the occurrence of complications, and the number of days of hospitalization. Statistical methods used in this study included number, percentage, mean, standard deviation, the chi-square test, independent two-sample t test, Pearson correlation, and regression analysis. Results: Female patients and those older than 64 years old were the majority in the studied patients undergone spine surgeries. Patients that received minimally invasive spine surgery had less intra-operative blood loss, intra-operative blood transfusion, postoperative complications, operation and anesthesia time in terms of medical care quality. They also had lower hospitalization days, hospitalization costs, and health insurance declaration points in terms of medical resources utilization. There were close relationships between blood loss, postoperative complications, and hospitalization days and health insurance declaration points for patients undergone the two different spinal surgeries.Conclusion: Minimally invasive spine surgery has less blood loss, intra-operative blood transfusion, postoperative complications, operation and anesthesia time in the quality of medical treatment. At the same time, the hospitalization days, hospitalization costs, and health insurance declaration amount in the medical resources utilization are all lower. If the medical expense is affordable for patients or if they have commercial insurance, they should consider the minimally invasive spine surgery to be the priority. |
