中央脊髓综合征管理的全国趋势：对16134例患者的分析
National trends in the management of central cord syndrome: an analysis of 16,134 patients.
作者信息
Brodell David W, Jain Amit, Elfar John C, Mesfin Addisu
机构信息
Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14625, USA.
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, 5th Floor, JH Outpatient Center (JHOC), Baltimore, MD 21287, USA.
出版信息
Spine J. 2015 Mar 1;15(3):435-42. doi: 10.1016/j.spinee.2014.09.015. Epub 2014 Sep 28.
BACKGROUND CONTEXT
Central cord syndrome (CCS) is a common cause of incomplete spinal cord injury. However, to date, national trends in the management and mortality after CCS are not fully understood.
PURPOSE
To analyze how patient, surgical, and institutional factors influence surgical management and mortality after CCS.
STUDY DESIGN
A retrospective cohort analysis.
PATIENT SAMPLE
The Nationwide Inpatient Sample (NIS) was queried for records of patients with a diagnosis of CCS from 2003 to 2010.
OUTCOME MEASURES
They included in hospital mortality and surgical management, including anterior cervical decompression and fusion (ACDF), posterior cervical decompression and fusion (PCDF), and posterior cervical decompression (PCD).
METHODS
Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, patient records with a diagnosis of CCS from 2003 to 2010 were selected from the NIS database and sorted by inpatient mortality and surgical management. Demographic information (age, gender, and race) and hospital characteristics were evaluated with χ(2)-tests for categorical variables and t tests for continuous variables. Multivariate logistic regression models controlled for confounding.
RESULTS
In this sample of 16,134 patients, a total of 39.7% of patients (6,351) underwent surgery. ACDF was most common (19.4%), followed by PCDF (7.4%) and PCD (6.8%). From 2003 to 2010, surgical management increased by an average of 40% each year. The overall inpatient mortality rate was 2.6%. Increasing age and comorbidities were associated with higher rates of patient mortality and a decreasing surgical rate (p<.01). Hospitals greater than 249 beds (p<.01) and the south (p<.01) were associated with a higher surgical rate. Rural hospitals (p<.01) and people in the second income quartile (p<.01) were associated with higher inpatient mortality.
CONCLUSIONS
Elderly patients with medical comorbidities are associated with a lower surgical rate and a higher mortality rate. Surgical management was more prevalent in the south and large hospitals. Mortality was higher in rural hospitals. It is important for surgeons to understand how patient, surgical, and institutional factors influence surgical management and mortality.
背景
中央脊髓综合征（CCS）是不完全性脊髓损伤的常见原因。然而，迄今为止，CCS治疗及死亡率的全国趋势尚未完全明确。
目的
分析患者、手术及机构因素如何影响CCS后的手术治疗及死亡率。
研究设计
一项回顾性队列分析。
患者样本
查询2003年至2010年全国住院患者样本（NIS）中诊断为CCS的患者记录。
观察指标
包括住院死亡率及手术治疗情况，其中手术治疗包括颈椎前路减压融合术（ACDF）、颈椎后路减压融合术（PCDF）及颈椎后路减压术（PCD）。
方法
采用国际疾病分类第九版临床修订本编码，从NIS数据库中选取2003年至2010年诊断为CCS的患者记录，并按住院死亡率及手术治疗情况进行分类。采用卡方检验分析分类变量的人口统计学信息（年龄、性别及种族）及医院特征，采用t检验分析连续变量。多因素逻辑回归模型用于控制混杂因素。
结果
在这16134例患者样本中，共有39.7%的患者（6351例）接受了手术。ACDF最为常见（19.4%），其次是PCDF（7.4%）和PCD（6.8%）。2003年至2010年，手术治疗每年平均增加40%。总体住院死亡率为2.6%。年龄增长及合并症与患者死亡率升高及手术率降低相关（p<0.01）。床位超过249张的医院（p<0.01）及南部地区（p<0.01）手术率较高。农村医院（p<0.01）及收入处于第二四分位数的人群（p<0.01）住院死亡率较高。
结论
合并内科疾病的老年患者手术率较低，死亡率较高。手术治疗在南部地区及大型医院更为普遍。农村医院死亡率较高。外科医生了解患者、手术及机构因素如何影响手术治疗及死亡率非常重要。
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