保险状况对急性脊柱骨折手术治疗的影响
The Influence of Insurance Status on the Surgical Treatment of Acute Spinal Fractures.
作者信息
Daly Michael C, Patel Madhukar S, Bhatia Nitin N, Bederman S Samuel
机构信息
*Department of Orthopaedic Surgery, Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts †Department of General Surgery, General Surgical Residency Training Program, Massachusetts General Hospital, Boston, Massachusetts ‡Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, California §Scoliosis and Spine Tumor Center, Texas Back Institute, Plano, TX.
出版信息
Spine (Phila Pa 1976). 2016 Jan;41(1):E37-45. doi: 10.1097/BRS.0000000000001177.
STUDY DESIGN
A retrospective, propensity score, multivariate analysis of the National Trauma Data Bank (NTDB) between 2008 and 2011.
OBJECTIVE
The aim of this study was to determine the relationship between insurance status and rates of surgery for acute spinal fractures with and without spinal cord injury (SCI).
SUMMARY OF BACKGROUND DATA
The decision for surgery in patients with spinal fractures is often based on fracture pattern and stability, associated SCI, and the presence of ligamentous and other associated injuries. It is poorly understood how nonclinical factors, such as insurance status, influence the decision for surgical intervention in patients sustaining spinal trauma.
METHODS
Using NTDB admission years 2008 to 2011, we included patients 18 to 64 years old who sustained a fracture of the cervical or thoracolumbar spine. Patients were excluded if they sustained polytrauma (Injury Severity Score ≥27) or a major injury (Abbreviated Injury Scale severity ≥3) to the head, thorax, or abdomen. Our main outcome measure was surgical versus nonsurgical treatment for spinal injury; our main predictor was insurance status. Hierarchical multivariate regression analysis and propensity scores were used to determine the relationship between insurance status and surgical treatment, controlling for other factors. We calculated adjusted odds ratios (ORs) for rates of surgery.
RESULTS
Our propensity score multivariate analysis demonstrated significantly higher rates of surgery in patients with SCI (OR = 11.76, P < 0.001), insurance (OR = 1.27, P < 0.001), white (OR = 1.21, P = 0.018) versus black race, blunt trauma (OR = 5.63, P < 0.001), shock (OR = 1.62, P < 0.001), higher Glasgow Coma Scale (GCS) score (OR = 1.02, P = 0.002), transfer from lower acuity hospital (OR = 1.51, P < 0.001), and treatment at teaching hospitals (OR = 1.49, P < 0.001). Multivariable subgroup analysis of SCI patients similarly revealed higher surgical rates for insured patients (OR = 1.46, P < 0.001) than those without insurance.
CONCLUSION
Patients with traumatic spine fractures were more likely to receive surgery if they were insured, regardless of the presence of SCI.
研究设计
对2008年至2011年间国家创伤数据库（NTDB）进行回顾性、倾向评分、多变量分析。
目的
本研究旨在确定保险状况与有无脊髓损伤（SCI）的急性脊柱骨折手术率之间的关系。
背景数据总结
脊柱骨折患者的手术决策通常基于骨折类型和稳定性、相关的脊髓损伤以及韧带和其他相关损伤的存在情况。对于诸如保险状况等非临床因素如何影响脊柱创伤患者的手术干预决策，人们了解甚少。
方法
利用NTDB 2008年至2011年的入院数据，我们纳入了年龄在18至64岁之间、患有颈椎或胸腰椎骨折的患者。如果患者遭受多发伤（损伤严重度评分≥27）或头部、胸部或腹部的重伤（简明损伤定级标准严重度≥3），则将其排除。我们的主要结局指标是脊柱损伤的手术治疗与非手术治疗；我们的主要预测因素是保险状况。采用分层多变量回归分析和倾向评分来确定保险状况与手术治疗之间的关系，并对其他因素进行控制。我们计算了手术率的调整比值比（OR）。
结果
我们的倾向评分多变量分析显示，脊髓损伤患者（OR = 11.76，P < 0.001）、有保险患者（OR = 1.27，P < 0.001）、白人（OR = 1.21，P = 0.018）与黑人相比、钝器伤患者（OR = 5.63，P < 0.001）、休克患者（OR = 1.62，P < 0.001）、格拉斯哥昏迷量表（GCS）评分较高者（OR = 1.02，P = 0.002）、从较低急症医院转来者（OR = 1.51，P < 0.001）以及在教学医院接受治疗者（OR = 1.49，P < 0.001）的手术率显著更高。对脊髓损伤患者的多变量亚组分析同样显示，有保险患者的手术率（OR = 1.46，P < 0.001）高于无保险患者。
结论
无论有无脊髓损伤，遭受脊柱创伤性骨折的患者如果有保险，更有可能接受手术治疗。
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