Predictors of Outcome after Laparoscopic Cholecystectomy

• Main Authors: Sheng-Tzu Hung, 洪聖慈
• Other Authors: Shiao-Chi Wu
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/48030765992961001810

碩士 === 國立陽明大學 === 醫務管理研究所 === 93 === Abstract Laparoscopic Cholecystectomy (LC) is a standard method to treat gallstone disease. It is suitable for various kinds of calculus. About 60 to 90 percent of Cholecystectomies are performed laparoscopically in America and Europe at present. This study analysis the claims database of National Health Insurance of 11,141 patients after Laparoscopic Cholecystectomy in 2001. Outcome indexes include in-hospital complication and 30-day readmission from patient level, hospital level, and physician level separately. According to the patient profile analysis, in-hospital complication rate was 2.64%. 30-day readmission rate was 3.89%. The results of GEE analysis of factors related to in-hospital complication was significant association with age, single, acute, private hospital, lower degree of hospital level, median-high hospital volume, and high physician volume. 30-day readmission was significant association with male, over 65 years old, single, comorbidity score ≧2, acute, community hospital, and high physician volume. According to the hospital profile analysis, 11,141 LC cases were performed in 171 hospitals in Taiwan. After adjusted the patient risk, in-hospital complication adjusted rate was 3.59%. 30-day readmission adjusted rate 5.46%. In-hospital complication rate was significant association with private hospital. 30-day readmission rate was significant association with degree of hospital level. According to the physician profile analysis, 11,141 LC cases were performed by 583 physicians in Taiwan. After adjusted the patient risk, in-hospital complication adjusted rate was 3.24%. 30-day readmission adjusted rate 4.17%. In-hospital complication rate was significant association with physicians who in the private hospital. 30-day readmission rate was significant association with physicians who in the community hospital and physician with 40-49 years of age. This study suggests that Bureau of National Health Insurance could audit the quality of care in the low volume hospital and physician in order to maintain outcome of surgery. The medical staff could give more care and discharge planning to elderly, acute, and single patients to reduce complication and readmission.