한국산학기술학회논문지 (Journal of the Korea Academia-Industrial cooperation Society)

  • 제18권12호
  • /
  • Pages.384-389
  • /
  • 2017
  • /
  • 1975-4701(pISSN)
  • /
  • 2288-4688(eISSN)
한국산학기술학회 (The Korea Academia-Industrial cooperation Society)
권호 표지
DOI QR코드

DOI QR Code

간종양 색전술 환자의 수혈 영향 요인

Predictors of Blood Transfusion in Hepatoma Embolization

  • 김상미 (한국폴리텍대학 의료정보과)
  • Kim, Sang-Mi (Department of Healthcare Informatics, Korea Polytechnic Colleges)
  • 투고 : 2017.09.12
  • 심사 : 2017.12.08
  • 발행 : 2017.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

본 연구의 목적은 우리나라에서 암 발생 빈도가 두 번째로 높은 간종양에서 혈관색전증을 시행한 환자의 수혈에 영향을 주는 요인을 분석하는 것이다. 건강보험심사평가원의 2014년 입원환자표본자료 중 주상병이 간종양(C22.0)으로 혈관색전술(M6644)을 시행한 19세 이상 퇴원환자 757건을 대상으로 하였다. 데이터는 STATA 12.0을 사용하여 기술통계, 카이제곱 및 로지스틱 회귀분석법으로 분석하였다. 종속변수인 수혈을 건강보험심사평가원 분류코드에서 전형 및 혈액성분제재료 코드가 발생한 경우를 유로 구분하였다. 독립변수로 환자 특성은 성, 연령, 의료보장유형, 입원경로, 빈혈, 질환 중증도로, 의료기관 특성은 의료기관 소재지, 병상수로 구분하였다. 간종양 색전술 환자의 수혈에 영향을 주는 요인을 분석한 결과, 상급종합병원의 경우 빈혈(Odds ratio (OR)=9.544, 95% confidence interval (CI)=3.362-27.097), 여자(OR=2.186, Cl=l.240-3.854), 65-75세(OR=0.506, CI=0.269-0.952), 1000병상 이상(OR=0.053, CI=0.018-0.151), 외래 경유(OR=0.211, CI=0.081-0.551), and 700-999병상(OR=0.105, CI=0.036-0.304)군이 수혈에 영향을 미쳤다. 종합병원의 경우 빈혈(OR=69.681, CI=8.545-568.246), 75세 이상(OR=0.112, CI=0.025-0.506)군이 수혈에 영향을 미쳤다. 의료기관간 수혈 현황과 영향 요인을 분석한 본 연구는 수혈 관리에 비용 효과적이며 양질의 수혈을 위한 기초자료로 활용 가능할 것이다.

This study was conducted to investigate the patient and hospital characteristics that affect receiving and non-receiving blood transfusion for hepatoma embolization. We analyzed data describing 757 patients of the Health Insurance Review and Assessment Service's 2011 claims sample data. Chi-squared and logistic regression analysis was performed using STATA 12.0. Logistic regression analysis revealed that anemia (Odds ratio (OR)=9.544, 95% confidence interval (CI)=3.362-27.097), female (OR=2.186, Cl=l.240-3.854), age 65-74 (OR=0.506, CI=0.269-0.952), 1000 over bed (OR=0.053, CI=0.018-0.151), out-department (OR=0.211, CI=0.081-0.551), and 700-999 bed (OR=0.105, CI=0.036-0.304) were significant predictors of blood transfusion in tertiary hospitals. Additionally, anemia (OR=69.681, CI=8.545-568.246) and aged 75 or over (OR=0.112, CI=0.025-0.506) were significant predictors of blood transfusion in general hospitals. This research would expected to cost effective and preliminary data of blood transfusion quality.

키워드

참고문헌

  1. van Bommel J, Siegemund M, Henny ChP, Ince C., "Heart, kidney, and intestine have different tolerances for anemia," TranslRes, vol. 151, no. 2, pp. 110-117, 2008. DOI: https://doi.org/10.1016/j.trsl.2007.11.001
  2. Tsui AK., Marsden PA., Mazer CD., et al. "Priming of hypoxia-inducible factor by neuronal nitric oxide synthase is essential for adaptive responses to severe anemia", Acad Sci USA, vol. 108, no. 42, pp. 17544-17549, 2011. DOI: https://10.1073/pnas.1114026108
  3. WHO, "Developing a National Policy and Guidelines on the Clinical Use of Blood Recommendations ", 2001.
  4. G.J. Murphy, B. C. Reeves, C.A. Rogers, S.I. Rizvi, L. Culliford, G.D. Angelini, "Increased Mortality, Postoperative Morbidity, and Cost After Red Blood Cell Transfusion in Patients Having Cardiac Surgery", Circulation vol. 116, pp. 2544-2552 2007. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.698977
  5. L. T. Goodnough, L. Shieh, E. Hadhazy, N. Cheng, P. Khari, P. Maggio, " Improved blood utilization using real-time clinical decision support', Transfusion, vol. 54, no. 5, pp. 1358-1365, May 2014. DOI: https://doi.org/10.1111/trf.12445
  6. L. T. Goodnough, p, Maggio, E. Hadhazy, L. Shieh, T. Hernandez-Boussard, P. Khari, N. Shah, "Restrictive blood transfusion practices are associated with improved patient outcomes;', Transfusion, vol. 54, no. 10pt2, pp. 2753-2759, October 2014. DOI: https://doi.org/10.1111/trf.12723
  7. Anthes E. "Evidence-based medicine: Save blood, save lives", NATURE, vol. 520, pp. 24-26, 2015. https://doi.org/10.1038/520024a
  8. K. D. Ellingson, M. R. P. Sapiano, K. A. Haass, A. A. Savinkina, M. L. Baker, K-W. Chung, R.A. Henry, J. J. Berger, M. J. Kuehnet, S. V. Basavaraju, " Continued decline in blood collection and transfusion in the United States-2015', Transfusion, vol. 57, no. S2, pp. 1588-1598, June 2017. DOI: https://doi.org/10.1111/trf.14165
  9. S. J. Park, "Global status and trends of bloodless surgery', Journal of Korean research society of transfusion alternatives blood management & transfusion alternatives, vol. 2 no. 1, pp. 39-54, Oct. 2012. https://doi.org/10.1177/030437547600200103
  10. M. R. Choi, " Impact factors associated with transfusion : based on cholecystectomy, total knee replacement, cesarean section", Yonsei University Graduate School of Public Health, 2005.
  11. J-Y. Oh, S-M. Kim, S-A. Lee, "The Analysis of Hospital Characteristics affecting Blood Transfusion to the patients under Knee or Hip Total Replacement Arthroplasty', Journal of the Korea Academia-Industrial cooperation Society vol. 16, no. 6, pp. 4031-4039, 2015. DOI: https://doi.org/10.5762/KAIS.2015.16.6.4031
  12. Health Insurance Review & Assessment Service, "Evaluation of Blood Transfusion", 2006.
  13. H. B. El-Serag H B, K. L. Rudolph, "Hepatocellular carcinoma: epidemiology and clinical gastroenterolog", Gastroenterology, vol. 132, no. 7, pp. 2557-2576, June, 2007. DOI: https://doi.org/10.1053/j.gastro.2007.04.061
  14. E. Gane, " Screening for hepatocellular carcinoma", Cancer Forum, vol. 33, pp. 115-119, 2009.
  15. J. Trojam, S. Zangos, A. A. Schnitzbauer, "Diagnostics and Treatment of Hepatocellular Carcinoma in 2016: Standards and Developments", Visceral Medicine, vol. 32, pp. 116-120, April, 2016. DOI: https://doi.org/10.1159/000445730
  16. e-country index,[Internet] Available from:http://www.index. go.kr, [cited 2017 Sept. 08]
  17. Korean Central Cancer Registry. Annual report of cancer statistics in Korea in 2012", [Internet]. 2014. http://www.ncc.re.kr/cancerStatsView.ncc accessed Sept., 08, 2017
  18. Health Insurance Review Agency. Steadily decreased blood production used in medical institutions. [cited 2016 April. 16], Available from: http://www.hira.or.kr accessed Sept., 08, 2017
  19. L. Kim, JA. Kim, S, Kim, "A guide for the utilization of Health Insurance Review and Assessment Service national patient samples". Epidemiol Health, vol. 36:e2014008, 2014. DOI: https://doi.org/10.4178/epih/e2014008
  20. J. R. Park, E. Alghamdi, S. Kim, H. O. Kim, "An Update of Maximum Surgical Blood Order Schedule in Elective Surgery', The Korean Journal of Blood Transfusion, vol. 26, no.1, pp. 38-46, April, 2015. DOI: https://doi.org/10.17945/kjbt.2015.26.1.38
  21. E. Bennett-Guerrero, Y. Zhao, S. M. O'Brien, "Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery", JAMA, vol. 3014, no. 14, pp. 1568-1575, October, 2010. DOI: https://doi.org/10.1001/jama.2010.1406
  22. M. E. Charlson, P. Pompei, K. L. Ales, C. R. MacKenzie, " A new method of classifying prognostic comorbidity in longitudinal studies: development and validation", J Chronic Dis, vol. 40, no. 5, pp. 373-383, 1987. DOI:https://doi.org/10.1016/0021-9681 87 90171-8
  23. H. S. Ahn, "The Effects of hospital and physician factors on hospital resource use", Seoul Univ., 1995.
  24. J. Joo, S. Kwon, S. Kim, " Determinants of Health Care Expenditure Per Case for Outpatient Care", The Korean Journal of Health Economics and Policy, vol. 15, no. 2, pp. 46-63, 2009.
  25. J-H. Park, "National Health Policy of Blood management", Blood Management& Transfusion Alternatives, vol. 4, no. 1, pp. 23-25, October 2014.
  26. H. Gombotz, P. H. Rehak, A. Shander, A. Hofmann, "Blood use in elective surgery: The Austrian benchmark study", Transfusion, vol. 47, no. 8, pp. 1468-1480, June, 2007. DOI: https://doi.org/10.1111/j.1537-2995.2007
  27. W. C. Wu, T.L Schifftner, W. G. Henderson, C. B. Eaton, R. M. Poses, G, Uttley, S. C. Sharma, M. Vezeridis, S. F. Khuri, P. D. Friedmann, " Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery", JAMA, vol. 297, no. 22, pp. 2481-2488, June, 2007. DOI: https://doi.org/10.1001/jama.297.22.2481