人工髖關節置換分析與應對策略─以南部某區域醫院為例

研究背景與目的： 台灣關節重建手術市場增長，導致醫療費用上升。為避免醫療成本超過TW-DRGs支付，醫院及骨科醫師需重視此議題。本研究分析南部某區域醫院近五年人工髖關節置換手術資料，探討不同患者條件與醫療費用差異，為院方及臨床骨科醫師提供策略參考。研究方法: 利用SPSS對髖關節置換手術申報案件進行T檢定和ANOVA分析，並用EXCEL分析該地區65歲以上人口髖關節置換術醫療需求趨勢。研究結果： 在TW-DRGs-20903全髖關節置換術的部分，執刀醫師人數在住院天數(P值：<0.001)及麻醉費(P值： <0.001)有顯著差異；入院來源在醫療總金額(P值：0.03)及特材費(P值：<0.001)有顯著差異；年齡在手術費 (P值：0.039)、輸血費(P值：0.013)及檢查費(P值：<0.001)有顯著差異；共病症在輸血費(P值： <0.001)有顯著差異；致病因素在檢查費(P值：0.012)有顯著差異。南部某地區65歲以上人口增加，醫療需求與相關開銷變化顯著，COVID-19疫情影響2020年手術數量，但2021年起手術數量回升。趨勢圖顯示成本控管良好。 而在TW-DRGs-20904部分髖關節置換術的部分，執刀醫師人數在特材費(P值：0.007)及麻醉費(P值：0.018)有顯著差異；入院來源在檢查費(P值：0.001)有顯著差異；年齡在檢查費(P值：0.001)有顯著差異；致病因素在檢查費(P值：0.023)及麻醉費(P值：0.021)有顯著差異。南部某地區65歲以上人口逐年增加，平均醫療費用上升，但2022年手術數量下降超過COVID-19期間，顯示成本控管不佳。結論討論與限制： 在全髖關節置換術中，影響因素包括入院來源、年齡、致病因素、共病症指數和執刀醫師數量。這些因素有助於醫院更精確地預測和分配資源，優化醫療服務。建議未來研究探索病患來源對醫療成本的影響，醫院應升級設備、縮短住院天數、增加手術量、減少非必要治療，以降低成本並提高醫療品質。健保制度應參考這些參數，細化TW-DRGs分類。 在部分髖關節置換術中，影響因素包括入院來源、年齡、致病因素及執刀醫師數量。外傷性患者的醫療成本高於病因性患者，建議預防老年性骨質疏鬆和跌倒問題，以減輕醫療負擔。醫師應選擇成本效益高的治療方式，醫療院所需優化流程，降低不必要支出。 本研究限於單一醫院數據，結果可能不適用於其他院所。建議未來研究納入多個機構數據，考慮疫情或政治衝突等外部因素，以提高研究的準確性和普遍性，助益醫療服務水準和體系穩定發展。

Background and Objectives The growth of the joint reconstruction surgery market in Taiwan has led to an increase in medical expenses. To prevent medical costs from exceeding TW-DRGs reimbursements, hospitals and orthopedic surgeons need to address this issue. This study analyzes the data of artificial hip replacement surgeries from the past five years at a regional hospital in southern Taiwan, examining the differences in medical costs across various patient conditions. The findings aim to provide strategic recommendations for hospital management and clinical orthopedic surgeons.Methods SPSS was used to perform T-tests and ANOVA analyses on the data from hip replacement surgery claims. Additionally, Excel was utilized to analyze the medical demand trends for hip replacement surgeries among the population aged 65 and above in the region.ResultsFor TW-DRGs-20903 total hip replacement surgeries: The number of surgeons significantly impacted the length of hospital stay (P < 0.001) and anesthesia costs (P < 0.001).Admission source significantly affected the total medical costs (P = 0.03) and special material costs (P < 0.001).Age significantly influenced surgery costs (P = 0.039), blood transfusion costs (P = 0.013), and examination costs (P < 0.001).Comorbidities significantly affected blood transfusion costs (P < 0.001).Etiology significantly impacted examination costs (P = 0.012).In the region, the population aged 65 and above increased, with significant changes in medical demand and related expenses. The COVID-19 pandemic affected the number of surgeries in 2020, but the numbers rebounded from 2021 onwards, indicating good cost control as shown in the trend graphs.For TW-DRGs-20904 partial hip replacement surgeries: The number of surgeons significantly impacted special material costs (P = 0.007) and anesthesia costs (P = 0.018).Admission source significantly affected examination costs (P = 0.001).Age significantly influenced examination costs (P = 0.001).Etiology significantly impacted both examination costs (P = 0.023) and anesthesia costs (P = 0.021).In this region, the population aged 65 and above increased yearly, with average medical expenses rising. However, the number of surgeries in 2022 decreased more than during the COVID-19 period, indicating poor cost control.Conclusions and Limitations For total hip replacement surgeries, factors affecting costs include admission source, age, etiology, comorbidities, and the number of surgeons. These factors help hospitals more accurately predict and allocate resources, optimizing medical services. Future research should explore the impact of patient source on medical costs. Hospitals should upgrade equipment, shorten hospital stays, increase surgery volumes, and reduce unnecessary treatments to lower costs and improve medical quality. The health insurance system should consider these parameters to refine TW-DRGs classifications. For partial hip replacement surgeries, factors affecting costs include admission source, age, etiology, and the number of surgeons. Traumatic patients incur higher medical costs than etiological patients. Preventing senile osteoporosis and falls is recommended to reduce the medical burden. Surgeons should choose cost-effective treatment methods, and medical institutions need to optimize processes to reduce unnecessary expenses. This study is limited to data from a single hospital, and the results may not be applicable to other institutions. Future research should include data from multiple institutions and consider external factors such as pandemics or political conflicts to enhance the accuracy and generalizability of the research, contributing to the stable development of medical services and systems.