Title page for etd-0812109-224135


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URN etd-0812109-224135
Author David Vi Lu
Author's Email Address davidlu@kmu.edu.tw
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Department Institute of Health Care Management
Year 2008
Semester 2
Degree Master
Type of Document
Language zh-TW.Big5 Chinese
Title The comparison of prevalence, medical expenditure and related factors between open appendectomy
and laparoscopic appendectomy
Date of Defense 2009-07-21
Page Count 76
Keyword
  • Open appendectomy
  • Average Length Of Stay
  • Medical Expenditure
  • Laparoscopic Appendectomy
  • Abstract Abstract
    Background and Objectives:
    Since 1894, open appendectomy (OA) has been the treatment of choice for acute appendicitis. In 1981 Semm performed the first laparoscopic appendectomy (LA). More than 2 decades later, the benefits of LA are still controversial. The goal of the present investigation was to compare the effectiveness of LA and OA based on a large administrative (The Bureau of National Health Insurance, BNHI) Research Database. The source of data analyzed was the administrative claims data from the BNHI Research Database.
    Methods:
    The objective of this retrospective study was based on the ICD-9-CM procedure code of 4701 (Laparoscopic appendectomy, LA) and 4709 (Open appendectomy, OA) respectively from a database of 20 million insurance population, Separate analyses were performed for uncomplicated (ICD-9-CM, 540.9) and complicated (presence of appendiceal perforation or abscess; ICD-9-CM 540.0 and 540.1) appendicitis. Exclusive criteria were: (1) Average length of stay exceeds 3 S.D. (n=1,262). (2) Gender unmentioned (n=243). All these data will analyze in multiple dimensions including length of hospital stay, in-hospital complications, in-hospital mortality, and rate of routine discharge between laparoscopic (LA) and open appendectomy (OA) based on The Bureau of National Health Insurance (BNHI) database.
    Results:
    We enrolled 11,118 patients underwent LA and 47,725 patients underwent OA during 2004 to 2007. The prevalence of LA increases gradually from 6.97 per 100,000 populations in 2004 to 21 per 100,000 populations in 2007. The prevalence of OA decreases gradually from 57.5 per 100,000 populations in 2004 to 44.86 per 100,000 populations in 2007. Patients underwent LA (3.25±1.51day) have significant lower length of hospital stay than OA (3.57±1.49 day) (p<0.001). We also found the trend that the annual medical expenditure of LA increases gradually but OA decreases gradually. In general, LA spends higher medical expenditure than OA. With respect to medical expenditure, higher length of hospital stay and co-morbidity are associated with more medical expenditure significantly.

    Conclusions:
    LA is the current developing trend of surgical treatments for appendicitis. LA can reduce length of hospital stay significantly. OA can reduce the medical expenditure in Taiwan. In our opinion, the results represent the native data in Taiwan and are very important for a good administration of public resources distribution.
    Advisory Committee
  • Chao-Yuan Wang - chair
  • Kwong-Leung Yu - co-chair
  • Ying-Chun Li - advisor
  • Hon-Yi Shi - advisor
  • Files
  • etd-0812109-224135.pdf
  • indicate access worldwide
    Date of Submission 2009-08-12

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