| Summary: | 碩士 === 臺灣大學 === 醫療機構管理研究所 === 98 === Background and objectives: Existing studies mostly looked at the effects of patient characteristics, surgeon and hospital characteristics on the utilization and outcomes of THR. However, types of bearing materials may also associate with medical utilization and outcomes of THR. Thus, the objectives of this study were to explore the medical utilization and outcomes of THR with different bearings and its related factors.
Method: The design of this study is a cross-sectional study. We analyzed the claims data of the National Health Insurance from 2007 to 2008. In order to analyze the medical utilization and outcomes within ninety days after discharge, patients with ICD-9-CM procedure codes as 8151 between 2007 to September 2008 were selected. Wilcoxon Two-Sample Test and Kruskal-Wallis Test were used to analyze medical utilization of patients, including the usage of artificial hip joints, length of stay, hospitalization expenditure, and the medical fees within thirty and ninety days after discharge. The logistic regression was used to reduce the confounding effects by predicting the probability of using ceramic-on-ceramic bearings for each patient. The propensity score was included in multiple regressions to analyze the medical utilization of THR with different bearings and its related factors. Moreover, the study also reported the medical outcomes, which were evaluated by postoperative mortalities, readmission rates and complication rates. However, statistical tests can’t be performed due to few adverse medical events.
Results: Among 395 cases, there were slightly more males, more patients aged 45-54 and 65-74. The most frequently seen primary diagnosis was osteoarthritis, followed by avascular necrosis. In addition, the average age of surgeons was 48.4 years old and the average seniority was 13 years. The majority of patients received health care from non-profit proprietary hospitals, medical centers, and in the jurisdiction of Taipei branch. In terms of the utilization of artificial hip joints, most patients adopted metal-on-polyethylene hip joints, only 14.7% use ceramic-on-ceramic bearings.
The average length of stay was 8 days and the average hospitalization expenditure was 114,995.0 points. Additionally, the average medical fees within thirty and ninety days after discharge were 3,976.7 and 7,253.4 points, respectively. In terms of medical outcomes, the mortalities within index hospitalization, thirty days and ninety days after discharge were 0.0%, 0.5% and 0.8%, respectively. The readmission rates within thirty days and ninety days after discharge were 2.3% and 4.3%, respectively. The complication rates within index hospitalization, thirty days and ninety days after discharge were 2.3%, 6.6% and 12.9%, respectively. All the adverse medical events occurred more frequently in the patients who adopted metal-on-polyethylene hip joints except for readmission rates. As shown by the logistic regression, patients who aged 65 years and older or received health care from district hospitals, Northern region and Kao-Ping branches were less likely to adopt ceramic-on-ceramic bearings. Furthermore, the hospitalization charge was significantly lower for patients with ceramic-on-ceramic bearings in the stepwise multiple regressions without propensity score. But it became statistically insignificant in the models with propensity score.
Conclusion: The multiple regressions with propensity score indicated that THR with different bearings was not significantly related to hospitalization expenditure and medical utilization after discharge. Nevertheless, the results still displayed that THR with ceramic-on-ceramic bearings was associated with lower medical utilization. We suggest that further research can conduct longitudinal studies to explore and compare long-term medical utilization and outcomes.
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