脊柱外科护理与结果评估项目（Spine SCOAP）：一种由外科医生主导的质量与安全方法。

The Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP): a surgeon-led approach to quality and safety.

作者信息

Lee Michael J, Shonnard Neal, Farrokhi Farrokh, Martz Dean, Chapman Jens, Baker Ray, Hsiang John, Lee Chong, Gholish Ray, Flum David

机构信息

*Department of Orthopaedic Spine Surgery, University of Chicago Medical Center, Chicago IL †Proliance Surgeons, Puyallup, WA ‡Virginia Mason Medical Center, Seattle, WA §Inland Neurosurgery and Spine Associates, Spokane, WA ¶Swedish Neuroscience Institute, Seattle, WA ‖Evergreen Health, Kirkland, WA; and **Jupiter Medical Center, Jupiter, FL.

出版信息

Spine (Phila Pa 1976). 2015 Mar 1;40(5):332-41. doi: 10.1097/BRS.0000000000000750.

DOI:10.1097/BRS.0000000000000750

PMID:25901980

Abstract

STUDY DESIGN

Prospective registry of spine surgery.

OBJECTIVE

To identify variation in utilization, processes of care, and outcomes in spine surgery to improve statewide quality and safety.

SUMMARY OF BACKGROUND DATA

Variability in the utilization and outcomes of elective spine surgery across different regions in the United States and internationally has become a growing focus of critical evaluation. In 2011, surgeons in Washington State created the Spine Surgical Care and Outcomes Assessment Program to address variability in use, process, and outcome of spine surgery.

METHODS

Prospective cohort study from consecutive spine fusion cases and 30% sampling of other spine procedures from up to 20 hospitals (2011-2013). Logistic regression models were developed using data from 10 quarters to determine factors associated with combined adverse events inclusive of index hospital death, reintervention, and adverse events not requiring intervention, and then applied to patients in the last 2 quarters.

RESULTS

A total of 10,166 (58.9 ± 13.4 yr, 52.2% females) underwent surgery including 3767 (37%) lumbar and 6399 (63%) cervical procedures. Of the total, 75.3% of the cohort had a spine fusion and among those, neurological symptoms were described in 92.5% of patients, with baseline limb pain numeric rating scale (NRS) scores of 5.9 among those classified as having neurological symptoms. The NRS mean score for back pain was 5.9 with a mean Oswestry Disability Index/Neck Disability Index of 44. There was significant intersite variation in rates of cigarette smoking among patients undergoing fusion surgery (range, 0%-40%) and rates of combined adverse events with 10 hospitals having a significantly lower observed/expected ratio and 3 having a significantly greater observed to expected ratio.

CONCLUSION

Spine Surgical Care and Outcomes Assessment Program identified significant variability in the indications, process of care, and outcomes related to spine surgery. This variability indicates the need for continued surveillance initiatives and point to opportunities for quality improvement and research.

LEVEL OF EVIDENCE

摘要

研究设计

脊柱手术前瞻性登记研究。

目的

确定脊柱手术在利用情况、护理过程和结果方面的差异，以提高全州范围内的质量和安全性。

背景数据总结

美国不同地区以及国际上选择性脊柱手术的利用情况和结果的变异性已成为批判性评估日益关注的焦点。2011年，华盛顿州的外科医生创建了脊柱手术护理与结果评估项目，以解决脊柱手术在使用、过程和结果方面的变异性问题。

方法

对连续的脊柱融合病例进行前瞻性队列研究，并从多达20家医院（2011 - 2013年）的其他脊柱手术中抽取30%的样本。使用10个季度的数据建立逻辑回归模型，以确定与包括索引医院死亡、再次干预以及无需干预的不良事件在内的综合不良事件相关的因素，然后将其应用于最后2个季度的患者。

结果

共有10166例患者（年龄58.9 ± 13.4岁，女性占52.2%）接受了手术，其中包括3767例（37%）腰椎手术和6399例（63%）颈椎手术。在全部患者中，75.3%的队列进行了脊柱融合手术，其中92.5%的患者有神经症状描述，被归类为有神经症状的患者基线肢体疼痛数字评分量表（NRS）评分为5.9。背痛的NRS平均评分为5.9，Oswestry功能障碍指数/颈部功能障碍指数平均为44。接受融合手术的患者中吸烟率存在显著的院间差异（范围为0% - 40%），综合不良事件发生率也存在差异，10家医院的观察/预期比值显著较低，3家医院的观察/预期比值显著较高。