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医疗保险受益人群中腰椎管狭窄症初诊患者的手术治疗模式。

Surgical treatment patterns among Medicare beneficiaries newly diagnosed with lumbar spinal stenosis.

机构信息

Quorum Consulting, Inc., San Francisco, CA 94104, USA.

出版信息

Spine J. 2010 Jul;10(7):588-94. doi: 10.1016/j.spinee.2010.02.026. Epub 2010 Apr 8.

Abstract

BACKGROUND CONTEXT

Lumbar spinal stenosis (LSS) is a prevalent degenerative condition in the elderly that can be managed medically or with surgical treatments. Recent studies have shown an increase in the utilization of surgery in the United States and great regional variations. An understanding of treatment patterns and costs in a population-based setting will help identify subgroup differences to help inform strategies for optimal care in patients with LSS.

PURPOSE

This study sought to examine surgical treatment rate and types, time to treatment, and patient characteristics that affect treatment patterns for newly diagnosed LSS in the US Medicare population.

STUDY DESIGN

A retrospective longitudinal study of administrative claims was performed on a 5% randomly selected sample of Medicare beneficiaries.

PATIENT SAMPLE

Six thousand two hundred sixty-five Medicare beneficiaries newly diagnosed with LSS in the first quarter of 2003 were identified and followed until the end of 2005.

OUTCOME MEASURES

Rate of LSS surgery, type and timing of LSS surgery, and Medicare costs.

METHODS

A "de novo" LSS patient cohort was defined as those with claims with a primary diagnosis of LSS during the period of January to March 2003, excluding those with a LSS diagnosis in 2002. These patients were stratified into surgery and nonsurgery cohorts based on the presence of procedure codes for LSS surgery. The surgery cohort was further divided into three subgroups: laminectomy or laminotomy only; fusion only; and fusion with laminectomy or laminotomy. All Medicare claims for these patients were extracted and reviewed through December 2005. Descriptive statistics were carried out for demographic characteristics, comorbidities, treatment rates, and Medicare costs.

RESULTS

This study indicated that 21% of LSS patients underwent surgery within 3 years of initial diagnosis. Surgery skews toward the healthier and younger patients. Overall, 78% of LSS surgeries were performed in the year of diagnosis, 13% in the second, and 9% in the third. Although laminectomies and laminotomies were the most frequently performed procedures across all years, a higher percentage of fusions were performed in addition to laminectomy or laminotomy in the second or third years after diagnosis than in the first year. The 3-year Medicare payments were $49,624 in the surgery cohort in comparison with $36,691 in the nonsurgery cohort. Patients who underwent a laminectomy/laminotomy alone incurred significantly lower Medicare payments ($42,293) than those who had fusion alone ($57,171) or laminectomy/laminotomy plus fusion ($63,555).

CONCLUSIONS

The surgical management of LSS varies with respect to timing and type of surgery provided. Such variation needs to be explained beyond demographic and comorbid factors.

摘要

背景

腰椎管狭窄症(LSS)是老年人中一种常见的退行性疾病,可以通过医学治疗或手术治疗。最近的研究表明,美国手术治疗的使用率有所增加,且地区差异较大。了解基于人群的治疗模式和成本将有助于确定亚组差异,以帮助为 LSS 患者制定最佳治疗策略。

目的

本研究旨在探讨美国医疗保险人群中,新诊断为 LSS 的患者的手术治疗率、手术类型、治疗时机以及影响治疗模式的患者特征。

研究设计

对医疗保险受益人的 5%随机抽样进行回顾性纵向研究。

患者样本

2003 年第一季度新诊断为 LSS 的 6265 名 Medicare 受益人为研究对象,并随访至 2005 年底。

观察指标

LSS 手术率、LSS 手术类型和时机,以及 Medicare 费用。

方法

将“初发”LSS 患者队列定义为在 2003 年 1 月至 3 月期间,有初次诊断为 LSS 的索赔,且在 2002 年无 LSS 诊断的患者。这些患者根据 LSS 手术的程序代码,分为手术组和非手术组。手术组进一步分为三个亚组:单纯椎板切除术或椎板切开术;单纯融合术;融合加椎板切除术或椎板切开术。提取并审查了所有患者的所有 Medicare 索赔至 2005 年 12 月。对人口统计学特征、合并症、治疗率和 Medicare 费用进行描述性统计分析。

结果

本研究表明,21%的 LSS 患者在初次诊断后 3 年内接受了手术。手术更倾向于健康和年轻的患者。总体而言,78%的 LSS 手术在诊断当年进行,13%在第二年,9%在第三年。尽管在所有年份中,椎板切除术和椎板切开术是最常进行的手术,但与第一年相比,第二年和第三年进行融合术加椎板切除术或椎板切开术的比例更高。手术组在 3 年内的 Medicare 支付费用为 49624 美元,而非手术组为 36691 美元。单纯行椎板切除术或椎板切开术的患者 Medicare 支付费用(42293 美元)显著低于单纯行融合术(57171 美元)或椎板切除术或椎板切开术加融合术(63555 美元)的患者。

结论

LSS 的手术治疗方式因手术时机和手术类型而异。这种差异需要在解释时考虑到人口统计学和合并症因素以外的因素。

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