| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 100 === Background: The decortication has been used for a long period time to solve the problem of empyema. The VATS has been introduced since 90s’ and first introduced before 2000. Previous clinical data is obtained from single center. Lack compared to other hospital or other centers to reveal truly factor affected the choice of op method, the complication or the post-op death.
Objective and Methology: from 2001 January to 2008 December, all patient who receive the operation of decortication for the reason of empyema, included from the database of NHI. We excluded the cancer or pre-teen patients, then we collect the data to run multiple logistic regression model to find out which factors is the key for choice of op method, the complication and even the post-op death. At final, we use the statistic skill to adjust the selection bias from the retrospective observational study.
Results: The female patient has 1.75 times chance to receive VATSD (95%CI:1.0,1.3). If the doctor’s age has over 55 years old, only 0.5times to perform VATSD (95%CI;0.4,0.6). Privacy hospital has 1.8 times to perform VATSD (95%CI:1.2,1.5), the Eastern Taiwan has less chance to perform this operation with only 0.25times than Taipei city (95%CI;0.16,0.39). But the year of 2008 had 6.1 times (95%CI;4.8,7.7) than year of 2000 to perform VATSD. The factors which affect the complication, is patient’s age who over 65 years old has 3.87times than the 15 years old boy (95%CI;2.9,5.1). Female doctor is also has higher complication than male doctors, 2.57 times (95%CI;1.9,3.3). Medical center is the safer place for complication 0.43 times of odd ratio (95%CI;0.35,0.54). the OD has 1.63 times mortality than VATSD (95%CI:1.34,1.99). post-op death is also higher at the age group who is 65 year old or above, 8.87 times than young man (95%CI;2.17,36.17). if post-op complication is happened, 3.72 times mortality than others (95%CI;3.0,4.59). 7.33times higher rate of mortality if your CCI is equal or over 3 (95%CI:5.55,9.68). The propensity score is similar as the multiple logistic regression model.
The post-op death rate is effected by the CCI, sex and SES of patient. The characteristics of hospital and doctor are less important to post-op death. The death rate is going down as the year.
Conclusion: The choice of operation method is influenced a lots by Charlson comorbidity index、sex of patient. Also the doctor’s age and amount of operation per year is important. The number of operation of VATSD is increasing as the year significantly. The complication rate is going up year by year but the death date is decreasing as result of operation. Although the complication rate is no significant different, the higher death date is found in the group of OD. Therefore, we concluded the VATSD is safer for the patients of empyema.
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