患者人口统计学特征和患者报告的结果能否预测脊柱手术后12个月的失访情况？
Do Patient Demographics and Patient-Reported Outcomes Predict 12-Month Loss to Follow-Up After Spine Surgery?
作者信息
Sielatycki J Alex, Parker Scott L, Godil Saniya S, McGirt Matthew J, Devin Clinton J
机构信息
*Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN†Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN‡Carolina Neurosurgery & Spine Associates, Charlotte, NC.
出版信息
Spine (Phila Pa 1976). 2015 Dec;40(24):1934-40. doi: 10.1097/BRS.0000000000001101.
STUDY DESIGN
Analysis of patients in a prospective registry.
OBJECTIVE
To determine the association between patient demographics, outcomes, and loss to follow-up 12 months after spine surgery.
SUMMARY OF BACKGROUND DATA
Obtaining outcomes 12 months after spine surgery remains a challenge. Loss to follow-up is believed to introduce biases and portend poor outcomes. Associations between follow-up, patient demographics, and outcomes in the degenerative spine population have not been studied.
METHODS
Patients undergoing surgery for degenerative spine disease at a single institution over a 2-year period were enrolled in a prospective registry. Patient demographics, comorbidities, treatment variables, readmissions/reoperations, and all 90-day surgical morbidity were collected. Patient-reported outcomes were recorded at baseline, 3-months, and 12-months after surgery. Multivariate logistic regression analysis was done to identify predictors of loss to follow-up.
RESULTS
A total of 1484 patients with baseline and 3-month outcomes were included. Two hundred thirty-three (15.7%) patients were lost to follow-up at 12 months. There was no difference in the baseline demographics (Sex: P = 0.46) and comorbidities (American Society of Anesthesiologists Grade: P = 0.06) of patients who had follow-up at 12-months versus those who did not, except age and employment status. Patients lost to follow-up at 12 months were younger (51.0 vs. 57.1 years; P < 0.001) and a higher proportion were employed preoperatively (45.9% vs. 41.7%, P = 0.24). Preoperative pain, disability, and quality of life was similar between the two groups (P > 0.05). There was no difference in 90-day morbidity (17.2% vs. 16.2%; P = 0.70) and 3-month pain, disability, quality of life, and patient satisfaction (85.0% vs. 88.3%; P = 0.63) (P > 0.05). In multivariate model, only younger age (P < 0.001) was an independent predictor of loss to follow-up at 12 months.
CONCLUSION
In our prospective spine registry the 12-month loss to follow-up rate is approximately 15%. The only independent predictor of loss to follow-up is younger age and preoperative employment.
LEVEL OF EVIDENCE
研究设计
对前瞻性登记册中的患者进行分析。
目的
确定脊柱手术后12个月患者人口统计学特征、结局与失访之间的关联。
背景数据总结
获取脊柱手术后12个月的结局仍然是一项挑战。失访被认为会引入偏差并预示不良结局。尚未研究退行性脊柱疾病患者的随访、人口统计学特征与结局之间的关联。
方法
在两年期间，将在单一机构接受退行性脊柱疾病手术的患者纳入前瞻性登记册。收集患者的人口统计学特征、合并症、治疗变量、再入院/再次手术情况以及所有90天手术并发症。在术前、术后3个月和12个月记录患者报告的结局。进行多因素逻辑回归分析以确定失访的预测因素。
结果
共纳入1484例有术前和3个月结局数据的患者。233例（15.7%）患者在12个月时失访。在12个月时有随访和无随访的患者之间，除年龄和就业状况外，基线人口统计学特征（性别：P = 0.46）和合并症（美国麻醉医师协会分级：P = 0.06）无差异。12个月时失访的患者更年轻（51.0岁对57.1岁；P < 0.001），术前就业的比例更高（45.9%对41.7%，P = 0.24）。两组术前疼痛、残疾和生活质量相似（P > 0.05）。90天并发症发生率（17.2%对16.2%；P = 0.70）以及3个月时的疼痛、残疾、生活质量和患者满意度（85.
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