Department of Orthopedic Surgery, Division of Spine Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
Spine (Phila Pa 1976). 2010 Jul 1;35(15):1454-9. doi: 10.1097/BRS.0b013e3181bef3cb.
Population-based database analysis.
To analyze trends in patient- and healthcare-system-related characteristics, utilization and outcomes associated with anterior cervical spine fusions.
Anterior cervical decompression and spine fusion (ACDF) is one of the most commonly performed surgical procedures of the spine. However, few data analyzing trends in patient- and healthcare-system-related characteristics, utilization and outcomes exist.
Data from 1990 to 2004 collected in the National Hospital Discharge Survey were accessed. ACDF procedures were identified. Five-year periods of interest (POI) were created for temporal analysis and changes in the prevalence and utilization of this procedure as well as in patient- and healthcare-system-related variables were examined. The changes in the occurrence of procedure-related complications were evaluated.
An estimated total of 771,932 discharges after ACDF were identified. Temporally, an almost 8-fold increase in total prevalence was accompanied by a similar increase in utilization (23/100.000 civilians/POI to 157/100.000/civilians/POI). The highest increase in utilization was observed in those > or =65 years (28-fold). Average age increased from 47.2 years to 50.5 years over time. Length of hospital stay decreased from 5.17 days to 2.38 days. Overall procedure-related complication rates decreased from 4.6% to 3.03%. The prevalence of hypertension, diabetes mellitus, hypercholesterolemia, obesity, pulmonary, and coronary artery increased over time among patients undergoing ACDF.
Despite limitations inherent to secondary analysis of large databases, we identified a number of significant changes in the utilization, demographics, and outcomes associated with ACDF, which can be used to assess the effect of changes in medical care, direct health care resources, and future research. The effect of the increased prevalence of comorbidities on medical practice remains to be evaluated. Further studies are necessary to evaluate causal relationships.
基于人群的数据库分析。
分析与前路颈椎融合术相关的患者和医疗系统特征、利用情况和结局的趋势。
前路颈椎减压和脊柱融合术（ACDF）是脊柱最常进行的手术之一。然而，关于患者和医疗系统相关特征、利用情况和结局的趋势分析数据很少。
获取了 1990 年至 2004 年全国住院调查中收集的数据。确定了 ACDF 手术。创建了五个感兴趣的时间段（POI），以分析该手术的流行率和利用率以及患者和医疗系统相关变量的变化，并评估与手术相关的并发症发生的变化。
估计总共识别出 771932 例 ACDF 后出院。从时间上看，总流行率几乎增加了 8 倍，利用率也相应增加（每 10 万平民/POI 从 23 例增加到 157 例）。利用率的增加在>65 岁的人群中最为显著（增加了 28 倍）。平均年龄从 47.2 岁增加到 50.5 岁。住院时间从 5.17 天减少到 2.38 天。总体手术相关并发症发生率从 4.6%降至 3.03%。在接受 ACDF 的患者中，高血压、糖尿病、高胆固醇血症、肥胖、肺部和冠状动脉疾病的患病率随着时间的推移而增加。
尽管对大型数据库的二次分析存在局限性，但我们发现 ACDF 的利用情况、人口统计学和结局发生了一些显著变化，可以用来评估医疗保健变化、直接医疗资源和未来研究的影响。共病患病率增加对医疗实践的影响仍有待评估。需要进一步研究来评估因果关系。
