Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago; and.
J Neurosurg Spine. 2014 Jun;20(6):606-16. doi: 10.3171/2014.3.SPINE13699. Epub 2014 Apr 11.
Unplanned hospital readmission represents a large financial burden on the Centers for Medicare and Medicaid Services, commercial insurance payers, hospitals, and individual patients, and is a principal target for cost reduction. A large-scale, multi-institutional study that evaluates risk factors for readmission has not been previously performed in patients undergoing lumbar decompression procedures. The goal of this multicenter retrospective study was to find preoperative, intraoperative, and postoperative predictive factors that result in unplanned readmission (UR) after lumbar decompression surgery.
The National Surgical Quality Improvement Program (NSQIP) database was retrospectively reviewed to identify all patients who received lumbar decompression procedures in 2011. Risk-adjusted multivariate logistic regression analysis was performed to estimate independent predictors of UR.
The overall rate of UR among patients undergoing lumbar decompression was 4.4%. After multivariate logistic regression analysis, anemia (odds ratio [OR] 1.48), dependent functional status (OR 3.03), total operative duration (OR 1.003), and American Society of Anesthesiologists Physical Status Class 4 (OR 3.61) remained as independent predictors of UR. Postoperative complications that were significantly associated with UR included overall complications (OR 5.18), pulmonary embolism (OR 3.72), and unplanned reoperation (OR 56.91).
There were several risk factors for UR after lumbar spine decompression surgery. Identification of high-risk patients and appropriate allocation of resources to reduce postoperative incidence may reduce the readmission rate.
计划外的医院再入院给医疗保险和医疗补助服务中心、商业保险公司、医院和患者个人带来了巨大的经济负担，也是降低成本的主要目标。以前从未在接受腰椎减压手术的患者中进行过大规模的多机构研究，以评估再入院的风险因素。这项多中心回顾性研究的目的是寻找导致腰椎减压手术后非计划性再入院（UR）的术前、术中及术后预测因素。
回顾性分析国家外科质量改进计划（NSQIP）数据库，以确定 2011 年接受腰椎减压手术的所有患者。采用风险调整多因素逻辑回归分析来估计 UR 的独立预测因素。
接受腰椎减压手术的患者 UR 总体发生率为 4.4%。经过多因素逻辑回归分析，贫血（比值比 [OR] 1.48）、依赖性功能状态（OR 3.03）、总手术时间（OR 1.003）和美国麻醉医师协会身体状况分类 4 级（OR 3.61）仍然是 UR 的独立预测因素。与 UR 显著相关的术后并发症包括总并发症（OR 5.18）、肺栓塞（OR 3.72）和非计划性再次手术（OR 56.91）。
腰椎减压手术后存在多种 UR 风险因素。识别高危患者并适当分配资源以降低术后发生率可能会降低再入院率。
