台灣老人下肢截肢

背景和目的：本研究將台灣過去18年間65歲以上下肢截肢老年患者分為65-74歲、75-84歲及85歲以上三組，討論他們截肢的特徵和醫療利用情況，並將他們與 65 歲以下的截肢者進行比較。方法：本研究為一項回顧性觀察研究。我們使用了 1996 年至 2013 年台灣全民健保參保人的全國代表性百萬抽樣檔作數據。分析截肢的基本特徵及其醫療使用數據。結果：65歲以上截肢患者，年齡越大則女性 (p = .002) 和因周圍血管疾病截肢 (p < .001) 的比例越高。截肢部位、住院透析、術後住院復健、手術費用和總住院費用則不同年紀組間無顯著差異。與 65 歲以下截肢者相比，65 歲以上下肢截肢老人中女性患者 (p < .001)、近端截肢 (p < .001)、非創傷性截肢 (p < .001) 和透析 (p < .001) 的比例更高。相比之下，接受術後復健治療的患者比例 (p < .001) 和相同截肢部位的手術費用 (p < .001) 低於 65 歲以下的患者。結論：在有截肢風險的老人中，年齡越大，須更關注女性和非糖尿病周圍血管疾病患者。很少老年截肢者接受住院復健，這提醒我們截肢復健不僅是義肢訓練。提高患者出院前的自我照護、轉位和活動能力的訓練不應受年齡限制。  Background and purpose: This study examines the characteristics and medical utilization of elderly patients with lower limb amputation in three different age groups, namely, young-old, old-old, and oldest-old, and compares them with amputees younger than 65. Methods: A retrospective study. We used data from a nationally representative sample of one million enrollees of the National Health Insurance in Taiwan from 1996 to 2013. The basic characteristics for amputation were identified, and the claims data for medical utilization were analyzed. Results: Among amputees older than 65, the higher the age, the higher the proportion of female (p = .002) and amputations due to peripheral vascular diseases (p = .000). There was no significant difference in amputation level, dialysis, inpatient rehabilitation, surgical cost, and hospital costs. Compared with amputees younger than 65, the proportion of females (p = .000), proximal amputations (p = .000), non-traumatic amputations (p = .000), and dialysis (p = .000) was higher in patients older than 65. In contrast, the proportion of patients receiving rehabilitation (p = .000) and the surgical cost of the same amputa-tion level (p = .000) were lower than for those younger than 65. Conclusion: In el-derly at risk of amputation, the higher the age, more attention must be paid to female and patient with non-diabetic peripheral vascular disease. Few elderly amputees re-ceived inpatient rehabilitation, which is a reminder that amputation rehabilitation is not simply prosthetic rehabilitation. Improving patients’ self-care, transfer, and mobil-ity skills before discharge should not be limited by age.