Buck J Stewart, Yoon S Tim
*Emory University School of Medicine; and †Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.
Spine (Phila Pa 1976). 2015 Sep 15;40(18):1444-50. doi: 10.1097/BRS.0000000000001025.
Retrospective database analysis.
To determine the incidence of durotomy in primary short-segment lumbar fusion and assess its clinical and economic impacts.
The incidence of durotomy during primary lumbar fusion and its economic impact are not well described.
The Nationwide Inpatient Sample was queried for all primary 1- or 2-level lumbar fusions performed in adults for lumbar spinal stenosis between 2009 and 2011; only elective cases without concurrent diagnoses of vertebral infection, fracture, or tumor were included. χ and t-tests were used as appropriate to compare categorical and continuous variables, respectively. Multivariate regression analysis was performed to identify factors independently associated with incidental durotomy, as well as total hospital charges, costs, and length of stay.
Among 17,232 cases, 802 incidental durotomies were identified (rate 4.65%). The multivariate odds of durotomy in the oldest patients (age ≥ 73) were 2.4 times greater than the odds of durotomy in the youngest patients (age ≤ 56; P < 0.0001). Durotomy was associated with increased neurological complications and longer hospital stay. Length of stay was a significant driver of cost. The multivariate odds of dural tears in teaching hospitals was significantly higher compared with nonteaching hospitals (odds ratio 1.27; 95% confidence interval, 1.06-1.52; P < 0.005). Durotomy was associated with a $10,885 increase in total hospital charges, and a $3,873 increase in estimated total costs (compared with no durotomy group with P < 0.0001).
Increasing age is a risk factor for durotomy in primary lumbar fusion. Durotomy is associated with neurological complications, increased length of stay, greater healthcare costs, and is more common in teaching hospitals. Length of stay is an independent driver of cost and complications.
回顾性数据库分析。
确定初次短节段腰椎融合术中硬脊膜切开术的发生率，并评估其临床和经济影响。
初次腰椎融合术中硬脊膜切开术的发生率及其经济影响尚未得到充分描述。
查询2009年至2011年期间在全国住院患者样本中所有因腰椎管狭窄症而对成人进行的初次单节段或双节段腰椎融合术；仅纳入无椎体感染、骨折或肿瘤并发诊断的择期病例。分别使用χ检验和t检验来比较分类变量和连续变量。进行多因素回归分析以确定与意外硬脊膜切开术、总住院费用、成本和住院时间独立相关的因素。
在17232例病例中，发现802例意外硬脊膜切开术（发生率4.65%）。年龄最大的患者（年龄≥73岁）发生硬脊膜切开术的多因素比值比是年龄最小的患者（年龄≤56岁）的2.4倍（P<0.0001）。硬脊膜切开术与神经并发症增加和住院时间延长有关。住院时间是成本的一个重要驱动因素。教学医院硬脊膜撕裂的多因素比值比显著高于非教学医院（比值比1.27；95%置信区间，1.06 - 1.52；P<0.005）。硬脊膜切开术使总住院费用增加10885美元，估计总成本增加3873美元（与无硬脊膜切开术组相比，P<0.0001）。
年龄增长是初次腰椎融合术中硬脊膜切开术的一个危险因素。硬脊膜切开术与神经并发症、住院时间延长、更高的医疗费用相关，且在教学医院更常见。住院时间是成本和并发症的一个独立驱动因素。
3级。
