Long-Term Outcome and Resource Utilization For Newly Diagnosed Colorectal Cancer Patients Received Surgical Intervention.

Autor: Hao-Ting Li, 李皓婷
Rok vydání: 2012
Druh dokumentu: 學位論文 ; thesis
Popis: 100
Background and Purpose In developed countries, colorectal cancer (Colorectal Cancer, CRC) is a very common and important disease. There is a rising trend in incidence and mortality of colorectal cancer in Taiwan. In the past, there are few studies about CRC treatments after surgery and medical resources utilization, and even to track medium-and long-term efficacy that using national database.Therefore, this study aimed to explore the new diagnosis of colorectal cancer inpatient and surgical patient demographics, disease characteristics, treatment characteristics and the medical treatment to the hospital characteristics distribution.To explore the CRC surgical patients who has postoperative complication, inhospital and 30-days mortality, and the efficacy of medical resourse and it’s impact factors. Also examining the outcome and resourse utilization of the patients received Laparoscopic surgery. Furthermore, follow the CRC surgical patients long-term efficacy, medical resource use and it’s impact factors. Methods This is a both cross-sectional and longitudinal study, and retrospective to use secondary database to analysis. During the study period January 1, 1998 to December 31, 2009, a total of 12 years. The subjects were newly diagnosed colorectal cancer and underwent surgery cases in early 1998 to the end of 2009, a total of 80,413 people. Data soures were use Registry for catastrophic illness patients(HV), Inpatient expenditures by admissions (DD), Registry for beneficiaries (ID), and Registry for contracted medical facilities (HOSB) four registration files. And all statistical analysis were performed using SPSS18.0 statistical software, used t-test, chi-square test, independent sample t-test, ANOVA test, logistic regression analysis, multivariate logistic regression analysis, multiple liner regression analysis, Kaplan-Meier survival analysis, Cox regression model to analyze the data and verify the hypothesis. Results In the study period of 1998-2009, the hospitalized patients of colorectal cancer continues to increase,the percentage of patients undergoing excision surgery increased from 71.4% in 1998 to 79.6% in 2009. Patients who had complications were increased between 12 years, and hospitalization mortality and length of stay were to decrease, but average inpatient medical costs were to increase. The surgical patients average age was 65.3 years old, 3.9% patients used laparoscopic surgery, and average length of stay were 18.5 days and the average inpatient medical costs were 148,058NTD. Patients who are male, age ≥ 75 years, CCI> 0, intestinal obstruction, peritonitis and intestinal perforation, and operated by low-volume hospitals and physicians, had high risk in secondary and major complications. And patients in age ≥ 75 years, colon cancer, open surgery, CCI> 0, complications, intestinal obstruction, peritonitis and intestinal perforation, and operated by low-volume hospitals and physicians, were high risk in inhospital and 30-days mortality. After adjusting for coveriates, age, gender, comorbidities, socioeconomic status, intestinal obstruction, peritonitis and intestinal perforation, the surgical approach, the hospital level, volume and complications are impact factors of CRC surgical patients inpatient medical use. Patients with major complication the length of stay and medical costs significantly more than without complicatons 12.4 days and 106,302NTD. Patients’ surgery by high volume surgeon the length of stay less than low volume surgeon 3.5 days, and medical costs less 21,771NTD. In the use of laparoscopic surgery, comorbidities, socioeconomic status, the property and level of hospital, and the volume of surgeon are impact factors. Used laparoscopic surgery were 2.15 times of high volume surgeons than low volume surgeons. The long-term efficacy, the impact factors of survival are age, diagnosis location, intestinal obstruction, peritonitis and intestinal perforation, hospital property, comorbidities, surgeon volume and complications. Conclusion and recommendations The study found that, comorbidity score, intestinal obstruction, peritonitis and intestinal perforation, hospital and surgeon volume all affect the post-operation outcome and medical resourse utilization. In long-term efficacy, age, diagnosis location, intestinal obstruction, peritonitis and intestinal perforation, hospital property, comorbidities, surgeon volume and complications are survival impact factors. Before surgery, patients should do well self health management to reduce comorbidity, and health care providers should learn more about patients condition, give the patients with comorbidities appropriate treatment, and provid comprehensive care after surgery to reduce the length of days in hospital and save medical costs. The study also found that laparoscopic surgery compared with traditional open surgery have better outcome and fewer medical resources utilization. The opportunities of performe laparoscopic surgery are more in high volume surgeons than low volume surgeons, and laparoscopic surgery requires time and cases to train and to complete the learning curve. Recommend high volume surgeons to give low volume surgeons more guidances and experiences, after that more manpower can provid this technique.
Databáze: Networked Digital Library of Theses & Dissertations
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