Relationship between Length of Stay and Quality of Life and Functional Status After Total Joint Replacement Patients

• Main Authors: Hsin-Shui Chen, 陳信水
• Other Authors: 戴志展
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/51278260933154191229

碩士 === 中國醫藥大學 === 醫務管理學研究所 === 96 === After the Bureau of National Health Insurance has implemented the reimbursement system case payment for THR and TKR since November 1997, the mean length of stay (LOS) for inpatient care has been shortened from 12.4 days to 10.4 days for THA, and 13.5 days to 11.5 days for TKA. DRG (diagnosis-related-group) program is scheduled to be implemented in the near future. Shortening of LOS is a future trend to reduce the medical cost and increase the profit for the total joint arthroplasty surgery. The purpose of this study is to find out the association of the LOS of inpatient care with the quality of life and the functional status in patients after total joint replacement. This is a longitudinal prospective study by using the disease-specific WOMAC-(TW) and SF-36(TW) for the assessment of functional status and quality of life after total joint replacement. We collected 40 patients, selected with a non-probability approach, the convenience sampling. The study duration was from December 1 2007 to April 30 2008. The statistic methods include descriptive statistics to describe the collection data and repeated measure ANOVA to analyses the variances before and after surgery. Multiple regressions were used to examine the correlation between the LOS and the functional status, as well as LOS and the quality of life. Based on the repeated measure ANOVA test, there are significant differences among the scores of WOMAC-TW before operation, before discharge and 3 months after operation. (F=68.49). We also found significant differences in all items of SF-36 subscales except vitality before surgery and that 3 months after surgery (t=0.31). There was a negative correlation between LOS and the physical component summary (PCS) of SF-36(p= -0.395), as well as LOS and the mental component summary (MCS) of SF-36(p= -0.329). Result from multi-variable lineal regression model suggest that pre-operation PCS score is a predictor for WOMAC functional outcome scale and retired or not and pre-operation WOMAC score is a predictor for post-operation PCS score. In conclusion, patients received the arthroplasty surgery will improve their functional and quality of life 3 months after operation. No correlation between LOS and patients characters as well as WOMAC and SF-36 score.