麻醉方式對於醫療利用與照護結果之影響:以髖骨手術為例

Abstract

Background: Most surgery has to be performed under anesthesia, and, with an aging population, hip surgery is a common procedure in orthopedics; the number of patients undergoing hip surgery has been increasing and health care costs continue to rise. There are few current studies on the effect of anesthesia type for hip surgery and the results are not consistent, therefore this study investigates hospital data of patients undergoing hip surgery in a medical center in Taiwan in order to explore the effect of different types of anesthesia on medical utilization and outcomes. Methods: For this retrospective study, the database includes hospitalization and discharge records for all inpatients from January 1, 2012, to December 31, 2012. Patients who underwent hip surgery were identified and divided into groups by anesthesia type: general or regional, and surgery type: hip replacement, and internal fixation of the hip. Patient demographics, inpatient costs, length of stay and postoperative outcomes were analyzed and compared. The statistical analyses contained Pearson chi-square tests, linear regression, and logistic regression. Results: Overall, 1,306 patients undergoing hip surgery were enrolled in the study; a total of 300 patients received internal fixation of the hip and 1,006 patients underwent hip replacement; of these, 10.1% were performed under regional and 89.9% under general anesthesia. Inpatient costs for patients who received regional anesthesia were lower than for general anesthesia in the all-patient groups, hip replacement surgery group and internal fixation of hip group. When we controlled for other variables, the inpatient costs were significantly lower in regional anesthesia groups; in addition, anesthesia type was not found to be significant for length of stay, and was not associated with In-hospital mortality. Conclusions: Anesthesia type does not affect length of stay and In-hospital mortality for hip surgery, but hip surgery patients who received regional anesthesia had lower inpatient costs than those who received general anesthesia.