择期前路颈椎间盘切除融合术（ACDF）及前路椎体次全切除术（ACCF）术后住院时间的影响因素分析：对某学术中心队列的多因素分析。
Preoperative factors affecting length of stay after elective anterior cervical discectomy and fusion with and without corpectomy: a multivariate analysis of an academic center cohort.
机构信息
From the Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
出版信息
Spine (Phila Pa 1976). 2014 May 20;39(12):939-46. doi: 10.1097/BRS.0000000000000307.
STUDY DESIGN
Retrospective cohort study of 183 patients who underwent elective anterior cervical discectomy and fusion (ACDF) at a single institution during a 2-year period.
OBJECTIVE
To determine which preoperative factors were independently associated with a prolonged hospital length of stay (LOS) after ACDF.
SUMMARY OF BACKGROUND DATA
ACDF has become the most common treatment modality for addressing cervical spine pathology. Extended LOS after ACDF is associated with increased costs and complications. There is a lack of conclusive data for factors affecting LOS after ACDF. This study aims to create a multivariate model to determine the association of various patient and operative characteristics with LOS after ACDF.
METHODS
Patients who underwent elective ACDF at a single academic institution between January 2011 and February 2013 were identified using billing records. Their charts were reviewed to collect variables available preoperatively such as patient demographics, comorbidities, and surgery planned. Patients were categorized as normal or extended LOS, with extended LOS defined as LOS more than the 75th percentile. A multivariate logistic regression was used to determine which factors were independently associated with extended LOS.
RESULTS
A total of 183 patients with ACDF were identified. The average LOS for this cohort was 2.0 ± 2.5 days (mean ± standard deviation). Extended LOS was defined as 3 days or more. Multivariate analysis revealed that preoperative factors independently associated with extended LOS were history of nonspinal malignancy (odds ratio [OR] = 4.9), history of pulmonary disease (OR = 4.0), and procedures that included corpectomy (OR = 4.5).
CONCLUSION
Patients with a history of nonspinal malignancy or pulmonary disease, as well as patients who underwent corpectomy, were more likely to have an extended LOS (ORs, 4.0-4.9). Of significant note, other factors that one might expect to be associated with extended LOS did not independently predict extended LOS in this analysis.
LEVEL OF EVIDENCE
研究设计
对在单家机构进行的为期 2 年的 183 例择期前路颈椎间盘切除术和融合术（ACDF）患者进行回顾性队列研究。
目的
确定哪些术前因素与 ACDF 后住院时间（LOS）延长独立相关。
背景资料概要
ACDF 已成为治疗颈椎病变的最常见方法。ACDF 后 LOS 延长与费用增加和并发症相关。目前尚无关于影响 ACDF 后 LOS 的因素的明确数据。本研究旨在建立一个多变量模型，以确定各种患者和手术特征与 ACDF 后 LOS 的关系。
方法
使用计费记录在单家学术机构确定 2011 年 1 月至 2013 年 2 月期间接受择期 ACDF 的患者。对他们的病历进行回顾，以收集术前可获得的变量，如患者人口统计学、合并症和计划手术。将患者分为正常 LOS 或延长 LOS，其中延长 LOS 定义为 LOS 超过第 75 百分位数。使用多元逻辑回归确定与延长 LOS 独立相关的因素。
结果
共确定了 183 例 ACDF 患者。该队列的平均 LOS 为 2.0 ± 2.5 天（平均值±标准差）。延长 LOS 定义为 3 天或以上。多因素分析显示，与延长 LOS 独立相关的术前因素是无脊柱恶性肿瘤病史（比值比[OR] = 4.9）、肺部疾病病史（OR = 4.0）和包括椎体切除术的手术（OR = 4.5）。
结论
有非脊柱恶性肿瘤或肺部疾病病史的患者，以及行椎体切除术的患者，更有可能出现延长的 LOS（OR，4.0-4.9）。值得注意的是，在这项分析中，其他可能与延长 LOS 相关的因素并未独立预测延长 LOS。
证据水平
3 级。
Zotero 插件