Pugely Andrew J, Martin Christopher T, Gao Yubo, Mendoza-Lattes Sergio
From the Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
Spine (Phila Pa 1976). 2014 Apr 20;39(9):761-8. doi: 10.1097/BRS.0000000000000270.
Retrospective review of a prospective cohort.
To determine the incidence, causes, and risk factors for 30-day unplanned readmissions after lumbar spine surgery.
The rising costs associated with lumbar spinal surgery have received national attention. Recently, the government has chosen to target 30-day readmissions as a quality measure. Few studies have specifically analyzed the incidence, causes, and risk factors for readmission in a multicenter patient cohort.
A large, multicenter clinical registry was queried for all patients undergoing lumbar spine surgery in 2012. Current Procedural Terminology codes were used to select patients undergoing lumbar discectomy, laminectomy, anterior and posterior fusions, and multilevel deformity surgery. Thirty-day readmissions rates and causes were identified and analyzed. Univariate and multivariate logistic regression analyses were used to identify patient characteristics, comorbidities, and operative variables predictive of readmission.
Overall, 695 of 15,668 patients undergoing lumbar spine surgery had unplanned 30-day hospital readmissions (4.4%). When separated by procedure type, readmissions were lowest after discectomy, 3.3%, and highest after deformity surgery, 9.0% (P < 0.001). The top causes for readmission were wound-related (38.6%), pain-related (22.4%), thromboembolic (9.4%), and systemic infections (8.0%). Predictors of readmission included advanced patient age more than 80 years (P = 0.03), African American race (P = 0.03), recent weight loss (P = 0.04), chronic obstructive pulmonary disorder (P < 0.01), history of cancer (P = 0.04), creatinine more than 1.2 (P < 0.01), elevated ASA class (P = 0.01), operative time more than 4 hours (P = 0.01), and prolonged hospital length of stay more than 4 days (P < 0.01).
Thirty-day unplanned readmission rates increased with procedure invasiveness. Both medical and surgical reasons contributed to readmission, many unavoidable. Surgeons should explore optimization measures for those at risk of early, unplanned readmission.
对前瞻性队列进行回顾性分析。
确定腰椎手术后30天内非计划再入院的发生率、原因及危险因素。
与腰椎手术相关的费用不断上涨已受到全国关注。最近，政府已将30天再入院率作为一项质量衡量指标。很少有研究专门分析多中心患者队列中再入院的发生率、原因及危险因素。
查询一个大型多中心临床登记数据库，获取2012年所有接受腰椎手术的患者信息。使用当前手术操作术语编码筛选接受腰椎间盘切除术、椎板切除术、前路和后路融合术以及多节段畸形手术的患者。确定并分析30天再入院率及原因。采用单因素和多因素逻辑回归分析确定可预测再入院的患者特征、合并症及手术变量。
总体而言，15668例接受腰椎手术的患者中有695例（4.4%）在30天内非计划再次入院。按手术类型划分，椎间盘切除术后再入院率最低，为3.3%，畸形手术后最高，为9.0%（P < 0.001）。再入院的主要原因是伤口相关（38.6%）、疼痛相关（22.4%）、血栓栓塞（9.4%）和全身感染（8.0%）。再入院的预测因素包括患者年龄超过80岁（P = 0.03）、非裔美国人种族（P = 0.03）、近期体重减轻（P = 0.04）、慢性阻塞性肺疾病（P < 0.01）、癌症病史（P = 0.04）、肌酐超过1.2（P < 0.01）、ASA分级升高（P = 0.01）、手术时间超过4小时（P = 0.01）以及住院时间延长超过4天（P < 0.01）。
30天非计划再入院率随手术侵袭性增加而升高。医疗和手术原因均导致再入院，许多是不可避免的。外科医生应探索针对有早期非计划再入院风险患者的优化措施。
3级。
