脊柱手术中意外硬脊膜切开的成本分析。
Cost analysis of incidental durotomy in spine surgery.
作者信息
Nandyala Sreeharsha V, Elboghdady Islam M, Marquez-Lara Alejandro, Noureldin Mohamed N B, Sankaranarayanan Sriram, Singh Kern
机构信息
From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
出版信息
Spine (Phila Pa 1976). 2014 Aug 1;39(17):E1042-51. doi: 10.1097/BRS.0000000000000425.
STUDY DESIGN
Retrospective database analysis.
OBJECTIVE
To characterize the consequences of an incidental durotomy with regard to perioperative complications and total hospital costs.
SUMMARY OF BACKGROUND DATA
There is a paucity of data regarding how an incidental durotomy and its associated complications may relate to total hospital costs.
METHODS
The Nationwide Inpatient Sample database was queried from 2008 to 2011. Patients who underwent cervical or lumbar decompression and/or fusion procedures were identified, stratified by approach, and separated into cohorts based on a documented intraoperative incidental durotomy. Patient demographics, comorbidities (Charlson Comorbidity Index), length of hospital stay, perioperative outcomes, and costs were assessed. Analysis of covariance and multivariate linear regression were used to assess the adjusted mean costs of hospitalization as a function of durotomy.
RESULTS
The incidental durotomy rate in cervical and lumbar spine surgery is 0.4% and 2.9%, respectively. Patients with an incidental durotomy incurred a longer hospitalization and a greater incidence of perioperative complications including hematoma and neurological injury (P < 0.001). Regression analysis demonstrated that a cervical durotomy and its postoperative sequelae contributed an additional adjusted $7638 (95% confidence interval, 6489-8787; P < 0.001) to the total hospital costs. Similarly, lumbar durotomy contributed an additional adjusted $2412 (95% confidence interval, 1920-2902; P < 0.001) to the total hospital costs. The approach-specific procedural groups demonstrated similar discrepancies in the mean total hospital costs as a function of durotomy.
CONCLUSION
This analysis of the Nationwide Inpatient Sample database demonstrates that incidental durotomies increase hospital resource utilization and costs. In addition, it seems that a cervical durotomy and its associated complications carry a greater financial burden than a lumbar durotomy. Further studies are warranted to investigate the long-term financial implications of incidental durotomies in spine surgery and to reduce the costs associated with this complication.
LEVEL OF EVIDENCE
研究设计
回顾性数据库分析。
目的
描述意外硬脊膜切开术在围手术期并发症和医院总费用方面的后果。
背景数据总结
关于意外硬脊膜切开术及其相关并发症与医院总费用之间的关系，数据匮乏。
方法
查询2008年至2011年的全国住院患者样本数据库。确定接受颈椎或腰椎减压和/或融合手术的患者，按手术入路分层，并根据术中记录的意外硬脊膜切开术分为不同队列。评估患者的人口统计学特征、合并症（查尔森合并症指数）、住院时间、围手术期结局和费用。采用协方差分析和多元线性回归评估作为硬脊膜切开术函数的调整后平均住院费用。
结果
颈椎和腰椎手术中的意外硬脊膜切开率分别为0.4%和2.9%。意外硬脊膜切开术患者的住院时间更长，围手术期并发症发生率更高，包括血肿和神经损伤（P<0.001）。回归分析表明，颈椎硬脊膜切开术及其术后后遗症使医院总费用额外增加了7638美元（95%置信区间，6489 - 8787；P<0.001）。同样，腰椎硬脊膜切开术使医院总费用额外增加了2412美元（95%置信区间，1920 - 2902；P<0.001）。特定入路的手术组在平均总住院费用方面也表现出类似的差异，这是硬脊膜切开术的函数。
结论
对全国住院患者样本数据库的这项分析表明，意外硬脊膜切开术会增加医院资源利用和费用。此外，颈椎硬脊膜切开术及其相关并发症似乎比腰椎硬脊膜切开术带来更大的经济负担。有必要进行进一步研究，以调查脊柱手术中意外硬脊膜切开术的长期经济影响，并降低与此并发症相关的费用。
证据级别
3级。
Zotero 插件