The Diffusion and Outcomes of LaparoscopicCholecystectomy in Taiwan

• Main Authors: Ta-Kuan Li, 李大寬
• Other Authors: Herng-Chia Chiu
• Format: Others
• Language: zh-TW
• Online Access: http://ndltd.ncl.edu.tw/handle/k37zw5

碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 97 === Objectives Laparoscopic cholecystectomy (LC) is a well-established surgical approach for treatment of gallbladder diseases. The rapid acceptance and widespread popularity of LC can be seen in almost every general surgery society around the world since its first application about 20 more years ago. First of all, the objective was to address if the use of laparoscopic cholecystectomy (LC) in Taiwan fitted the model, namely the diffusion of innovations. By using the National Health Insurance Research Database (1996-2006), the effectiveness and use of medical resource of LC vs. open cholecystectomy (OC) in Taiwan was examined thereafter. Then the relationship between clinical results, use of resources, and acceptance of LC was investigated to recognize factors influencing the use of LC in Taiwan during 1997-2006. Methods It was a retrospective, sequential cross-sectional study. According to the National Health Insurance Research Database 142,113 cholecystectomies, including 102,001 LC and 40,112 OC were undertaken from 1997 to 2006. Interested measures were: 1) rates of cholecystectomy 2) use of LC or OC 3) adverse clinical outcomes - overstay and mortality 4) variation in use of image study or blood transfusion 5) use of resources - total hospital cost and length of stay. Results The use of LC in Taiwan fitted to the model – diffusion of innovations. The annual mean LC acceptance increased rapidly. The rate of LC over total cholecystectomy reached its saturation after 2001. The LC acceptance was higher in medical centers than local regional hospitals (73% vs. 68%, p=.028), lower in east Taiwan districts than V northern-, mid- and southern districts (64%, 71%, 72%, 72%, p=.010), and lower in county than in metropolitan (61% vs. 73%) . Cases with overuse of image study or blood transfusion were more likely to be older, be male, have comorbidity and have acute cholecystitis. Mortality rate was lower in LC rather than OC group (0.31% vs. 2.52%, p<.0001). The use of medical resources in both groups decreased during the 10 year period. Length of stay was lower in LC group (5.06±3.619 vs. 12.65±6.018, p<.0001). Total cost was 49,451±21,103 in LC group and 83,031±55,134 in OC group, p<.0001. Cases used more hospital cost and length of stay were also more likely to be older, be male, have comorbidity and have acute cholecystitis. Conclusions In Taiwan, the use of LC fitted the diffusion model well since its introduction in 1990. LC was more likely accepted in the female, the younger, who had less comorbidity and had no acute disease. The characteristics of LC group were not like the OC group’s at all. In Taiwan, the increase of LC acceptance was due to it satisfied the inherent demand. LC had better clinical results and better use of resources than OC did. However they were 2 different cohorts. A population-based study using a research database like this could address issues about one surgical approach well. To determine whether different surgical approach had a better cost-effectiveness result, a prospective, randomized case-control study should be designed.