Walcott Brian P, Hanak Brian W, Caracci James R, Redjal Navid, Nahed Brian V, Kahle Kristopher T, Coumans Jean-Valery C E
Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
Surg Neurol Int. 2011 Jan 24;2:7. doi: 10.4103/2152-7806.76144.
Herniated intervertebral discs can result in pain and neurological compromise. Treatment for this condition is categorized as surgical or non-surgical. We sought to identify trends in inpatient surgical management of herniated intervertebral discs using a national database.
Patient discharges identified with a principal procedure relating to laminectomy for excision of herniated intervertebral disc were selected from the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project - Agency for Healthcare Research and Quality, Rockville, MD), under the auspices of a data user agreement. These surgical patients did not undergo instrumented fusion. To account for the Nationwide Inpatient Sample weighting schema, design-adjusted analyses were used. The estimates of standard errors were calculated using SUDAAN software (Research Triangle International, NC, USA). This software is based on the International Classification of Diseases, 9(th) Revision, Clinical Modification (ICD-9-CM); a uniform and standardized coding system.
Using International Classification of Disease 9(th) Revision clinical modifier (ICD-9 CM) procedure code 80.51, we were able to identify disc excision, in part or whole, by laminotomy or hemilaminectomy. The incidence of laminectomy for the excision of herniated intervertebral disc has decreased dramatically from 1993 where 266,152 cases were reported [CI = 22,342]. In 2007, only 123,398 cases were identified [CI = 12,438]. The average length of stay in 1993 was 4 days [CI = 0.17], and in 2007 it decreased to just 2 days [CI = 0.17]. Both these comparisons were significantly different at P < 0.001. The average inflation adjusted (2007 buying power) charge of the procedure in 1993 was 14,790.87 USD [CI = 916.85]. This value rose in 2007 to 24,639 USD [CI = 1,485.51]. This difference was significant at P < 0.001.
National estimates indicate that the incidence of inpatient laminectomy for the excision of herniated intervertebral disc has decreased significantly. This trend is multifactorial and is likely related to developments in outcomes research, the growing popularity of alternative procedures (intervertebral instrumented fusion), and transition to an ambulatory setting of surgical care.
椎间盘突出可导致疼痛和神经功能损害。这种疾病的治疗分为手术治疗和非手术治疗。我们试图利用一个全国性数据库来确定椎间盘突出症住院手术治疗的趋势。
在数据用户协议的支持下，从全国住院患者样本（医疗保健成本和利用项目 - 医疗保健研究与质量局，马里兰州罗克维尔）中选择主要手术与椎间盘突出切除术相关的患者出院病例。这些手术患者未进行器械融合。为了考虑全国住院患者样本加权方案，采用了设计调整分析。使用SUDAAN软件（美国北卡罗来纳州研究三角国际公司）计算标准误差估计值。该软件基于《国际疾病分类》第9版临床修订本（ICD - 9 - CM）；这是一个统一且标准化的编码系统。
使用国际疾病分类第9版临床修订本（ICD - 9 CM）手术编码80.51，我们能够确定部分或全部椎间盘切除术，通过椎板切开术或半椎板切除术。椎间盘突出切除术的椎板切除术发生率自1993年报告266,152例[CI = 22,342]以来已大幅下降。2007年，仅确定了123,398例[CI = 12,438]。1993年的平均住院时间为4天[CI = 0.17]，2007年降至仅2天[CI = 0.17]。这两个比较在P < 0.001时均有显著差异。1993年该手术的平均通货膨胀调整后（2007年购买力）费用为14,790.87美元[CI = 916.85]。2007年该值升至24,639美元[CI = 1,485.51]。此差异在P < 0.001时具有统计学意义。
全国估计表明，椎间盘突出切除术的住院椎板切除术发生率显著下降。这一趋势是多因素的，可能与结果研究的进展、替代手术（椎间器械融合）的日益普及以及手术护理向门诊环境的转变有关。
