Influence of Surgical Volume and Type of Anesthesia on Medical Utilization and Clinical Outcomes after Tympanoplasty

• Main Authors: Cheng-Cheng Huang, 黃晟承
• Other Authors: Hon-Yi Hsi
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/31196604608395728734

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 === 105 === Purpose： The objects of this study were chronic otitis media patients receiving tympanoplasty (Type 1, 2). We purposed to analyze the effects of the hospital volume, surgeon volume, and type of anesthesia on the medical outcomes and medical resource utilization. Methods： Based on the data provided by the National Health Insurance Academic Database, a retrospective transection study was performed, including adult patients (> 18 years old) who were hospitalized for tympanoplasty from 2001 to 2013, and excluding cases whose main ICD-9 diagnostic code was not chronic otitis media, collecting a total of 2,206 people into the study. The subjects were divided into two groups according to the hospital volume, surgeon volume, and type of anesthesia methods. The effects of the outpatient cost within a month of discharge, hospital stay and total medical expenses on the medical resource utilization and postoperative complications were analyzed. Results： High hospital volume group had significantly longer hospital stay and higher total medical expense compared to the low hospital volume group (4.46 days ± 2.07 vs. 3.79 ± 1.77 days; $44,871.9 ± 13,873 vs. $41,243 ± 12,192) (p<0.05). There were also significantly longer hospital stay and higher total medical expense for the high surgeon volume group compared to the low surgeon volume group (4.7 days vs. 3.8 days; $44,871.9 vs. $41,243) (p<0.05). The local anesthesia group had shorter hospital stay and lower total medical expense compared to the general anesthesia group. (3.60 days ± 1.65 vs. 4.05 days ± 1.92; $32,186.3 ± 7645.9 vs. $44,088.1 ± 12,677.9) (p<0.05). For the postoperative efficacy, the data showed that the number of cases in both groups which needed re-operation was zero. For most complications after discharge, there was no significant difference on the hospital and surgeon volume. Conclusions and Suggestions： Compared with previous studies on hospital volume and surgeon volume for different surgeries, the results are different. To examine the cause, most complex or difficult surgeries have learning curves for the surgeons and the factor of teamwork in the hospital, resulting in high hospital volume and surgeon volume groups have lower hospital stay and total medical expense. However, the surgical procedures for this study may be relatively easy to learn, surgeons need fewer operations to be skilled. The teamwork among the medical team staff is simpler, fewer mistakes can be made during the process, therefore, the importance of hospital volume and surgeon volume can not be revealed. With respect to different hospital levels, district and regional hospitals have shorter hospital stay compared to medical centers. Concerning the formulation of government policy, tympanoplasty can be recommended to be performed in more district and regional hospitals, reducing the surgical volumes of medical centers, achieving the purpose of hierarchical medical classification, but also save medical resources. Comparing local anesthesia with general anesthesia, the hospital stay and total medical expense were significantly less, but there was no significant difference in outpatient follow-up cost and re-operation rate. Local anesthesia for the surgery should be encouraged in order to reduce the use of medical resources.