利用 ACS-NSQIP 确定影响择期后路腰椎融合术后住院时间的因素。
Using the ACS-NSQIP to identify factors affecting hospital length of stay after elective posterior lumbar fusion.
机构信息
From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, New Haven, CT.
出版信息
Spine (Phila Pa 1976). 2014 Mar 15;39(6):497-502. doi: 10.1097/BRS.0000000000000184.
STUDY DESIGN
Retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2010 that included 1861 patients who had undergone elective posterior lumbar fusion.
OBJECTIVE
To characterize factors that were independently associated with increased hospital length of stay (LOS) in patients who had undergone elective posterior lumbar fusion.
SUMMARY OF BACKGROUND DATA
Posterior lumbar spine fusion is a common surgical procedure used to treat lumbar spine pathology. LOS is an important clinical variable and a major determinant of inpatient hospital costs. There is lack of studies in the literature using multivariate analysis to examine specifically the predictors of LOS after elective posterior lumbar fusion.
METHODS
Patients who underwent elective posterior lumbar fusion from 2005 to 2010 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Preoperative and intraoperative variables were extracted for each case and a multivariate linear regression was performed to assess the contribution of each variable to LOS.
RESULTS
A total of 1861 patients who had undergone elective posterior lumbar fusion were identified. The average age for patients in this cohort was 60.6 ± 13.9 years (mean ± standard deviation) with a body mass index of 30.3 ± 6.2 kg/m. Of the total patients, 44.7% of patients were male. LOS was in the range from 0 days to 51 days. Multivariate linear regression identified age (P < 0.001), morbid obesity (body mass index ≥ 40 kg/m, P < 0.001), American Society of Anesthesiologists class (P = 0.001), operative time (P < 0.001), multilevel procedure (P = 0.001), and intraoperative transfusion (P < 0.001) as significant predictors of extended LOS.
CONCLUSION
The identified preoperative and intraoperative variables associated with extended LOS after elective posterior lumbar fusion may be helpful to clinicians for patient counseling and postoperative planning.
LEVEL OF EVIDENCE
研究设计
这是一项回顾性队列研究，分析了美国外科医师学会国家外科质量改进计划数据库 2005 年至 2010 年期间的 1861 例接受择期后路腰椎融合术患者的资料。
目的
明确与择期后路腰椎融合术患者住院时间延长（LOS）相关的独立因素。
背景资料概要
后路腰椎融合术是一种常见的治疗腰椎疾病的手术。LOS 是一个重要的临床变量，也是决定住院费用的主要因素。但目前缺乏使用多变量分析来专门研究择期后路腰椎融合术后 LOS 预测因素的研究。
方法
从美国外科医师学会国家外科质量改进计划数据库中筛选出 2005 年至 2010 年期间接受择期后路腰椎融合术的患者。提取每个病例的术前和术中变量，并进行多元线性回归分析，以评估每个变量对 LOS 的贡献。
结果
共纳入 1861 例接受择期后路腰椎融合术的患者。该队列患者的平均年龄为 60.6±13.9 岁（均值±标准差），体重指数为 30.3±6.2kg/m。总患者中，44.7%为男性。LOS 范围为 0 至 51 天。多元线性回归分析确定年龄（P<0.001）、病态肥胖（体重指数≥40kg/m，P<0.001）、美国麻醉医师协会分级（P=0.001）、手术时间（P<0.001）、多节段手术（P=0.001）和术中输血（P<0.001）是 LOS 延长的显著预测因素。
结论
确定与择期后路腰椎融合术后 LOS 延长相关的术前和术中变量可能有助于临床医生为患者提供咨询和术后计划。
证据等级
3。
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