原 著
本邦のくも膜下出血治療の動向 ─公開DPCデータを用いた検討─
2021 年 49 巻 1 号 p. 26-33
詳細
2021 年 49 巻 1 号 p. 26-33
With the introduction of the diagnosis procedure combination (DPC) in Japan, it has become possible to study precise disease data. In this study, we analyzed the current state of subarachnoid hemorrhage (SAH) using the DPC data.
From the Ministry of Health, Labor, and Welfare website, we accessed the DPC evaluation subcommittee in the Central Social Insurance Medical Council. We examined the current treatment state of SAH using its aggregation from the MDC01 database for each diagnostic group classification from fiscal year (FY) 2012 to FY 2015.
From FY 2012 to FY 2015, the DPC data were obtained from 1,774, 1,804, 2,942, and 3,191 hospitals, respectively, and 17,131, 17,627, 18,468, and 17,246 patients with SAH discharged, respectively. Although the number of conservative and clipping treatments decreased from FY 2012 to FY 2015, the number of coiling and drainage treatments slightly increased. The proportion of clipping treatment for all surgical treatments declined from 70.3% to 63.5% during this period. The proportion of elderly people (≥ 80 years) increased from 14.3% to 18.0% between FY 2012 and FY 2015, and the mortality rate at discharge was similar between FY 2012 (18.9%) and FY 2015 (19.9%).
In FY 2015, of the 17,246 cases of SAH, the mild condition group had 8,976 (52.0%) cases (JCS < 10), while the severe group (JCS ≥ 10) had 8,270 (48.0%) cases. The conservative treatment, other operations, coiling, drainage, and clipping treatments were performed for 4,972 (29%), 331 (2%), 1,922 (11%), 2,439 (14%), and 7,582 cases (44%), respectively, and the proportion of severe cases was 42.5%, 53.2%, 37.9%, 63.4%, and 48.9%, respectively. In the severe group, the proportion of elderly people with conservative treatment was 42.4% and was highest in all treatments. At discharge, the mortality rate was 38.2% with conservative treatments and particularly high in the severe group (82.0%). On the contrary, the mortality rate at discharge in clipping treatment was 10.0% which was lowest among all treatments.
The analysis of the DPC data clarified the current state of SAH treatment in Japan. The DPC data may be an essential tool for monitoring disease trends.
