Outcome and medical utilization of spontaneous intracerebral hemorrhage patients after brain surgery

• Main Authors: Chun-Wei Chang, 張峻瑋
• Other Authors: Herng-Chia Chiu
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/ve7xsz

碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 103 === Objectives: Spontaneous intracerebral hemorrhage (SICH) is an important etiology to cause mortality and morbidity in elders. It can not only hurts the patients, but also affects their families and even the whole society. According to the data from 1992, in Taiwan, there are 73 persons have spontaneous ICH in erery 100,000 people and mortality rate in one month after ICH is as high as 26~30%. The purpose of this study is to analysis the outcome and medical utilization of patients with ICH after brain surgery and further find the factors that affect the prognosis and medical utilization of the patients. Methods: This study is a second database analysis. We analysis the data of 19,321 patients who have ICH (ICD-9:431) and brain surgery (OP code:01.39) from 1996~2009 in database of National Health Insurance Administration. Analytical method including two-sample t-test, chi-square test, logistic regression, generalized estimating equations, Kaplan-Meier analysis, cox proportional hazards model.We used statistical tool SPSS 20.0. Results: The incidence of spontaneous ICH in Taiwan is 44.76 in every 100,000 people which incidence rate decreases in people who older than 45 years old but increase in people who younger than 45 years old. The operation rate of people who have ICH is 13.7% ; mortality after brain surery is 24.5% and complication rate after surgery is 42.7% ; average length of stay(LOS) is 27.2 days, and average total hospital cost is NT316,142 ; 14-day and 30-day re-admission rate are 28.2% and 35.3%, separately. (ICH-related re-admisison rate are 12.8% and 13.7%). One year mortality rate is 30.6%. High-volume hospitals have lower in-patients mortality (OR=0.60, 95%CI=0.51~0.70, P<0.001) and 14-day, 30-day re-admisison rate. Total cost and length of stay of ICH patients with brain surgery in medical center are high then distrinct and local hospital. Conclusion: The patients than have ICH and brain surgery will have lower inpatient mortality, 14-day, 30-day re-admission and higer hospital complication, lengh of hospital stay and cost in high-volume hospitals. Male, elder, low socioeconomic status and CCI point more than 1 will have higher one year mortality and cost after brain surgery. The results of this study can be a reference for Ministry of health and welfare to make a better policy for spontaneous intracerebral hemorrhage.