| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 104 === Background: Taiwan is a hyperendemic area of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and patients with chronic hepatitis might have promoted to hepatocellular carcinoma (HCC) and liver cirrhosis in decades. Once contracted with HCC, the patients will have tremendous impacts on family and the society. The aim of this study was to estimate distributions of liver cancer patients with cirrhosis or with other cancers or both, trends of procedures of laparoscopic or open liver resection, and to explore the risk factors for outcome and the utilization of medical resources occurred.
Methods: A cross-sectional research design was adopted. Data set was obtained from the National Health Research Institute, which is a twelve-year (2000-2011) claimed data on the National Health Insurance. There were 43,287 patients with a diagnosis code for primary liver cancer and procedures code for hepatic resection following laparoscopic or open resection used for analysis. Patients were divided into four groups that depended on what complications they have including light or severe liver cirrhosis, other cancers, and both. This study focused on medical characteristics of patients and hospitals, and outcome variables of in-hospital mortality, transfusion, length of stay and medical costs. Comparisons of patients and hospital characteristics and outcomes variables were performed using SPSS 20.0 for the chi-square test, t-test, ANOVA, logistic regression, and linear regression where appropriate.
Result：There were more than five times on the increase in the liver cancer patients with cirrhosis or other cancers or both in this period. The dominant procedure of hepatic resection was traditional open abdomen operation. The risk factors for transfusion and in-hospital mortality are the patients with severe cirrhosis and with higher Charlson comorbidity index (CCI). The risk factors for length of stay and in-hospital medical costs are male, aged below 44 years old, low economic status, contracted with other cancers, regional hospitals and so on.
Conclusion: For the better usage of medical resources utilization, the patients with hepatocellular carcinoma should be carefully selected and evaluated prior to the operation. Medical institutes may establish timely transferred networks and benchmarking with hospitals with excellent performance and good reputation related to hepatic resection.
|
|---|
