Section of Neurosurgery, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA.
Neurosurgery. 2009 Dec;65(6):1011-22; discussion 1022-3. doi: 10.1227/01.NEU.0000360347.10596.BD.
Patients undergoing surgery for degenerative cervical spine disease may require future surgery for disease progression. We investigated factors related to the rate of additional cervical spine surgery, the associated length of stay, and hospital charges.
The was a longitudinal retrospective cohort study using Washington state's 1998 to 2002 state inpatient databases and International Classification of Diseases-Ninth Revision-Clinical Modification (ICD-9) codes to analyze patients undergoing degenerative cervical spine surgery. Multivariate Poisson regression to identify patient and surgical factors associated with reoperation for degenerative cervical spine disease was used. Multivariate linear regressions to identify factors associated with length of stay and hospital charges adjusted for age, sex, year of surgery, primary diagnosis, payment type, discharge status, and comorbidities were also used.
A total of 12,338 patients underwent initial cervical spine surgeries from 1998 to 2002; the mean follow-up duration was 2.3 years, and 688 patients (5.6%) underwent a reoperation (2.5% per year). Higher reoperation rates were independently associated with younger patients (P < 0.001) and a primary diagnosis of disc herniation with myelopathy (P = 0.011). Ventral surgery (P < 0.001) and fusion (P < 0.001) were both associated with lower rates of reoperation; however, a high correlation (Spearman's rho = 0.82; P < 0.001) made it impossible to determine which factor was dominant. Longer length of stay was independently associated with nonventral approaches (+1.0 day; P < 0.001) and fusion surgery (+0.8 day; P < 0.001). Greater hospital charges were independently associated with nonventral approaches (+$2900; P < 0.001) and fusion surgery (+$9600; P < 0.001).
Patients undergoing surgery for degenerative cervical spine disease undergo reoperations at the rate of 2.5% per year. An initial ventral approach and/or fusion seem to be associated with lower reoperation rates. An initial nonventral approach and fusion were more expensive.
患有退行性颈椎疾病的患者可能需要进行后续手术以控制疾病进展。本研究旨在调查与颈椎疾病再次手术的发生率、住院时间和住院费用相关的因素。
本研究采用华盛顿州 1998 年至 2002 年的住院患者数据库和国际疾病分类第九版临床修订版（ICD-9）代码，对接受退行性颈椎手术的患者进行了一项纵向回顾性队列研究。使用多变量泊松回归分析确定与退行性颈椎疾病再次手术相关的患者和手术因素。还使用多变量线性回归分析确定与住院时间和住院费用相关的因素，这些因素根据年龄、性别、手术年份、主要诊断、支付类型、出院状态和合并症进行了调整。
共有 12338 例患者在 1998 年至 2002 年期间接受了初始颈椎手术，平均随访时间为 2.3 年，688 例（5.6%）患者进行了再次手术（2.5%/年）。较低的再次手术率与较年轻的患者（P < 0.001）和伴有脊髓病的椎间盘突出症的主要诊断（P = 0.011）独立相关。前路手术（P < 0.001）和融合术（P < 0.001）均与较低的再次手术率相关；然而，两者之间存在高度相关性（Spearman 相关系数= 0.82；P < 0.001），使得无法确定哪种因素占主导地位。较长的住院时间与非前路入路（+1.0 天；P < 0.001）和融合手术（+0.8 天；P < 0.001）独立相关。较高的住院费用与非前路入路（+2900 美元；P < 0.001）和融合手术（+9600 美元；P < 0.001）独立相关。
患有退行性颈椎疾病的患者每年有 2.5%的患者需要进行再次手术。初次前路手术和/或融合术似乎与较低的再次手术率相关。初次非前路入路和融合术的费用更高。
