Department of Neurosurgery, College of Medicine, University of South Florida, Tampa, Florida, USA.
J Neurosurg Spine. 2010 Jul;13(1):61-6. doi: 10.3171/2010.3.SPINE09530.
OBJECT The objective of this work was to search a national health care database of patients diagnosed with cervical spine fractures in the US to analyze discharge, demographic, and hospital charge trends over a 10-year period. METHODS Clinical data were derived from the Nationwide Inpatient Sample (NIS) for the years 1997 through 2006. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with cervical spine fractures with and without spinal cord injury (SCI) were identified using the appropriate ICD-9-CM codes. The volume of discharges, length of stay (LOS), hospital charges, total national charges, discharge pattern, age, and sex were analyzed. National estimates were calculated using the HCUPnet tool. RESULTS Approximately 200,000 hospitalizations were identified. In the non-SCI group, there was a 74% increase in hospitalizations and charges between 1997 and 2006, but LOS changed minimally. There was no appreciable change in the rate of in-hospital mortality (< 3%), but discharges home with home health care and to skilled rehabilitation or nursing facilities increased slightly. In the SCI group, hospitalizations and charges increased by 29 and 38%, respectively. There were no significant changes in LOS or discharge status in this group. Spinal cord injury was associated with increases in LOS, charges, and adverse outcomes compared with fractures without SCI. Total national charges associated with both groups combined exceeded $1.3 billion US in 2006. CONCLUSIONS During the studied period, increases in hospitalizations and charges were observed in both the SCI and non-SCI groups. The percentage increase was higher in the non-SCI group. Although SCI was associated with higher adverse outcomes, there were no significant improvements in immediate discharge status in either group during the 10 years analyzed.
目的 本研究旨在检索美国国家医疗保健数据库中诊断为颈椎骨折的患者，以分析 10 年间的出院情况、人口统计学特征和医院费用趋势。
方法 临床数据来源于 1997 年至 2006 年全国住院患者样本（NIS）。NIS 由医疗保健研究与质量局维护，代表美国非联邦医院所有出院患者的 20%随机分层样本。使用适当的 ICD-9-CM 编码识别伴有和不伴有脊髓损伤（SCI）的颈椎骨折患者。分析出院人数、住院时间（LOS）、医院费用、全国总费用、出院模式、年龄和性别。使用 HCUPnet 工具计算全国估计值。
结果 共确定了约 20 万例住院患者。在非 SCI 组中，1997 年至 2006 年期间，住院人数和费用分别增加了 74%，但 LOS 变化很小。住院病死率（<3%）没有明显变化，但出院回家接受家庭保健和康复或护理设施的人数略有增加。在 SCI 组中，住院人数和费用分别增加了 29%和 38%。在该组中，LOS 和出院情况没有明显变化。与无 SCI 骨折相比，SCI 与 LOS、费用和不良结局的增加相关。2006 年，两组合计的全国费用超过 13 亿美元。
结论 在研究期间，SCI 和非 SCI 组的住院人数和费用均有所增加。非 SCI 组的增长百分比更高。尽管 SCI 与较高的不良结局相关，但在分析的 10 年内，两组的即时出院状况均无明显改善。
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