Missios Symeon, Rahmani Redi, Bekelis Kimon
Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Neuromodulation. 2014 Jul;17(5):451-5; discussion 455-6. doi: 10.1111/ner.12101. Epub 2013 Aug 7.
Spinal cord stimulators (SCS) are increasingly placed in the United States in both the inpatient and outpatient setting. Although these interventions appear to be safe, the characteristics of the patients selected for ambulatory procedures have not been investigated.
We performed a retrospective cohort study involving 4843 patients who underwent outpatient and 4197 who underwent inpatient SCS placements and were registered in State Ambulatory Surgery Databases and State Inpatient Databases, respectively, for New York, California, Florida, and North Carolina from 2005 to 2008.
In a multivariate analysis, male gender (odds ratio (OR) 1.22, 95% confidence interval (CI), 1.12, 1.33), high volume hospitals (OR 2.16, 95% CI, 1.94, 2.41), and Caucasian race (OR 1.25, 95% CI, 1.10, 1.41) were significantly associated with outpatient procedures. Higher Charlson Comorbidity Index (OR 0.36, 95% CI, 0.24, 0.54) and Medicare/Medicaid insurance (OR 0.75, 95% CI, 0.67, 0.83) were associated with a decreased chance of outpatient procedures. The rate of 30-day postoperative readmissions was higher among inpatients. Institutional charges were significantly lower for outpatient lumbar discectomies. The median total charge for inpatient hospitalization after SCS placement was $60,624 as compared with $22,288 for the outpatient setting (p < 0.0001).
Access to ambulatory SCS placement appears to be more common for Caucasians, male patients, with private insurance, and fewer comorbidities, in the setting of higher volume hospitals. Further investigation is needed in the direction of mapping these disparities for appropriate resource utilization.
在美国，脊髓刺激器（SCS）越来越多地应用于住院和门诊患者。尽管这些干预措施似乎是安全的，但对于选择进行门诊手术的患者特征尚未进行研究。
我们进行了一项回顾性队列研究，涉及2005年至2008年在纽约、加利福尼亚、佛罗里达和北卡罗来纳州的州门诊手术数据库和州住院数据库中分别登记的4843例接受门诊SCS植入手术的患者和4197例接受住院SCS植入手术的患者。
在多变量分析中，男性（优势比（OR）1.22，95%置信区间（CI）为1.12至1.33）、高容量医院（OR 2.16，95%CI为1.94至2.41）以及白种人（OR 1.25，95%CI为1.10至1.41）与门诊手术显著相关。较高的查尔森合并症指数（OR 0.36，95%CI为0.24至0.54）和医疗保险/医疗补助保险（OR 0.75，95%CI为0.67至0.83）与门诊手术机会减少相关。住院患者术后30天再入院率较高。门诊腰椎间盘切除术的机构收费显著较低。SCS植入术后住院患者的住院总费用中位数为60,624美元，而门诊手术为22,288美元（p < 0.0001）。
在高容量医院环境中，白种人、男性患者、有私人保险且合并症较少的患者似乎更常接受门诊SCS植入手术。需要进一步研究以明确这些差异，以便合理利用资源。
