成人 Chiari Ⅰ型畸形手术相关并发症及资源利用：一项基于人群的研究。
Complications and Resource Use Associated With Surgery for Chiari Malformation Type 1 in Adults: A Population Perspective.
作者信息
Greenberg Jacob K, Ladner Travis R, Olsen Margaret A, Shannon Chevis N, Liu Jingxia, Yarbrough Chester K, Piccirillo Jay F, Wellons John C, Smyth Matthew D, Park Tae Sung, Limbrick David D
机构信息
Departments of *Neurological Surgery and #Otolaryngology and Divisions of ‖Biostatistics, §Infectious Diseases, and ¶Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri; ‡Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
出版信息
Neurosurgery. 2015 Aug;77(2):261-8. doi: 10.1227/NEU.0000000000000777.
BACKGROUND
Outcomes research on Chiari malformation type 1 (CM-1) is impeded by a reliance on small, single-center cohorts.
OBJECTIVE
To study the complications and resource use associated with adult CM-1 surgery using administrative data.
METHODS
We used a recently validated International Classification of Diseases, Ninth Revision, Clinical Modification code algorithm to retrospectively study adult CM-1 surgeries from 2004 to 2010 in California, Florida, and New York using State Inpatient Databases. Outcomes included complications and resource use within 30 and 90 days of treatment. We used multivariable logistic regression to identify risk factors for morbidity and negative binomial models to determine risk-adjusted costs.
RESULTS
We identified 1947 CM-1 operations. Surgical complications were more common than medical complications at both 30 days (14.3% vs 4.4%) and 90 days (18.7% vs 5.0%) postoperatively. Certain comorbidities were associated with increased morbidity; for example, hydrocephalus increased the risk for surgical (odds ratio [OR] = 4.51) and medical (OR = 3.98) complications. Medical but not surgical complications were also more common in older patients (OR = 5.57 for oldest vs youngest age category) and male patients (OR = 3.19). Risk-adjusted hospital costs were $22530 at 30 days and $24852 at 90 days postoperatively. Risk-adjusted 90-day costs were more than twice as high for patients experiencing surgical ($46264) or medical ($65679) complications than for patients without complications ($18880).
CONCLUSION
Complications after CM-1 surgery are common, and surgical complications are more frequent than medical complications. Certain comorbidities and demographic characteristics are associated with increased risk for complications. Beyond harming patients, complications are also associated with substantially higher hospital costs. These results may help guide patient management and inform decision making for patients considering surgery.
背景
1型 Chiari 畸形（CM-1）的疗效研究因依赖小型单中心队列而受到阻碍。
目的
利用管理数据研究成人 CM-1 手术相关的并发症和资源利用情况。
方法
我们使用最近验证的《国际疾病分类，第九版，临床修订本》编码算法，通过州住院数据库对 2004 年至 2010 年加利福尼亚州、佛罗里达州和纽约州的成人 CM-1 手术进行回顾性研究。结局包括治疗后 30 天和 90 天内的并发症和资源利用情况。我们使用多变量逻辑回归来确定发病风险因素，并使用负二项式模型来确定风险调整后的成本。
结果
我们识别出 1947 例 CM-1 手术。术后 30 天（14.3% 对 4.4%）和 90 天（18.7% 对 5.0%）时，手术并发症比医疗并发症更常见。某些合并症与发病率增加相关；例如，脑积水增加了手术（比值比 [OR]=4.51）和医疗（OR = 3.98）并发症的风险。医疗并发症而非手术并发症在老年患者（最年长者与最年轻者年龄组相比，OR = 5.57）和男性患者（OR = 3.19）中也更常见。风险调整后的住院费用在术后 30 天为 225,30 美元，术后 90 天为 24,852 美元。经历手术（46,264 美元）或医疗（65,679 美元）并发症的患者的风险调整后 90 天费用是无并发症患者（18,880 美元）的两倍多。
结论
CM-1 手术后并发症很常见，且手术并发症比医疗并发症更频繁。某些合并症和人口统计学特征与并发症风险增加相关。并发症不仅对患者造成伤害，还与医院成本大幅增加相关。这些结果可能有助于指导患者管理，并为考虑手术的患者提供决策依据。
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