*Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY; and †Department of Health Economics, Baylor Health Care Systems, Dallas, TX.
Spine (Phila Pa 1976). 2013 Oct 15;38(22):1970-6. doi: 10.1097/BRS.0b013e3182a62527.
Retrospective review.
To analyze the trends in complications and mortality after spinal fusions.
Utilization of spinal fusions has been increasing during the past decade. It is essential to evaluate surgical outcomes to better identify patients who benefit most from surgical intervention. Integration of empiric evidence from large administrative databases into clinical decision making is instrumental in providing higher-quality, evidence-based, patient-centered care.
This study used Nationwide Inpatient Sample data from 2001 through 2010. Patients who underwent spinal fusions were identified using the CCS (Clinical Classifications Software) and ICD-9 (International Classification of Diseases, 9th Revision) codes. Data on patient comorbidities, primary diagnosis, and postoperative complications were obtained via ICD-9 diagnosis codes and via CCS categories. National estimates were calculated using weights provided as part of the database. Time trend analysis for average length of stay, total charges, mortality, and comorbidity burden was performed. Univariate and multivariate models were constructed to identify predictors of mortality and postoperative complications.
An estimated 3,552,873 spinal fusions were performed in the United States between 2001 and 2010. The national bill for spinal fusions increased from $10 billion to $46.8 billion. Today, patients are older and have a greater comorbidity burden than 10 years ago. Mortality remained relatively constant at 0.46%, 1.2%, and 0.14% for cervical, thoracic, and lumbar fusions, respectively. Morbidity rates showed an increasing trend at all levels. Multivariate analysis of 19 procedures and patient-related risk factors and 9 perioperative complications identified 85 statistically significant (P< 0.01) interactions.
The data on perioperative risks and risk factors for postoperative complications of spinal fusions presented in this study is pivotal to appropriate surgical patient selection and well-informed risk-benefit evaluation of surgical intervention.
N/A.
回顾性研究。
分析脊柱融合术后并发症和死亡率的趋势。
在过去十年中，脊柱融合术的应用一直在增加。评估手术结果至关重要，以便更好地确定从手术干预中获益最多的患者。将来自大型行政数据库的经验证据纳入临床决策对于提供更高质量、基于证据、以患者为中心的护理至关重要。
本研究使用了 2001 年至 2010 年全国住院患者样本数据。使用 CCS（临床分类软件）和 ICD-9（国际疾病分类，第 9 版）代码识别接受脊柱融合术的患者。通过 ICD-9 诊断代码和 CCS 类别获取患者合并症、主要诊断和术后并发症的数据。使用数据库中提供的权重计算全国估计值。对平均住院时间、总费用、死亡率和合并症负担进行时间趋势分析。构建单变量和多变量模型以确定死亡率和术后并发症的预测因素。
在美国，2001 年至 2010 年间估计进行了 3552873 例脊柱融合术。脊柱融合术的全国账单从 100 亿美元增加到 4680 亿美元。如今，患者比 10 年前年龄更大，合并症负担也更大。颈椎、胸椎和腰椎融合术的死亡率分别保持在 0.46%、1.2%和 0.14%相对稳定。在所有水平，发病率呈上升趋势。对 19 种手术和患者相关风险因素以及 9 种围手术期并发症进行多变量分析，确定了 85 个具有统计学意义的（P<0.01）相互作用。
本研究中提供的脊柱融合术围手术期风险和术后并发症风险因素数据对于适当的手术患者选择和明智的手术干预风险效益评估至关重要。
N/A。
