Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Spine (Phila Pa 1976). 2018 Mar 1;43(5):356-363. doi: 10.1097/BRS.0000000000001450.
Retrospective cohort study.
The aim of the study was to determine readmission rates and predictors of readmission after posterior cervical fusion (PCF).
PCFs are common spinal operations for a variety of spinal disorders including cervical myelopathy, unstable fractures, cervical deformity, and tumors. Data elaborating on risk factors for 30-day readmission are limited.
Data were collected from the 2006 to 2013 American College of Surgeons National Surgical Quality Improvement Program database. Predictors of 30-day readmission comprising patient demographics, comorbidities, operative features, and postoperative complications were identified through logistic multivariable regression.
A total of 3401 patients met study criteria. Rate of 30-day readmission was 6.20%. Multilevel fusion was performed in 69.16% of patients. Postoperative infection was the most reason, accounting for 17.06% of all readmissions. Age older than 70 years (odds ratio [OR] = 1.61, P = 0.012), renal failure requiring dialysis (OR = 3.69, P = 0.011), anemia (OR = 1.57, P = 0.006), multilevel fusion (OR = 1.61, P = 0.012), surgical site infections (OR = 20.4, P < 0.001), wound dehiscence (OR = 19.08, P < 0.001), postoperative pneumonia (OR = 2.75, P = 0.01), pulmonary embolism (OR = 15.39, P < 0.001), and progressing renal insufficiency (OR = 10.13, P = 0.061) were significant predictors of hospital readmission.
The identified predictors of readmission after PCF can improve patient counseling, identification of high-risk patients, and guide changes in healthcare delivery pathways. Patients with modifiable risk factors such as anemia and kidney failure may benefit from preoperative optimization. In addition, postoperative complications represent a key target for intervention.
回顾性队列研究。
本研究旨在确定颈椎后路融合术（PCF）后再入院率和再入院的预测因素。
PCF 是一种常见的脊柱手术，用于治疗多种脊柱疾病，包括颈椎病、不稳定骨折、颈椎畸形和肿瘤。关于 30 天再入院风险因素的数据有限。
数据来自 2006 年至 2013 年美国外科医师学会国家手术质量改进计划数据库。通过逻辑多变量回归确定 30 天再入院的预测因素，包括患者人口统计学、合并症、手术特征和术后并发症。
共有 3401 名患者符合研究标准。30 天再入院率为 6.20%。69.16%的患者行多节段融合。术后感染是最主要的原因，占所有再入院的 17.06%。年龄大于 70 岁（比值比[OR] = 1.61，P = 0.012）、需要透析的肾衰竭（OR = 3.69，P = 0.011）、贫血（OR = 1.57，P = 0.006）、多节段融合（OR = 1.61，P = 0.012）、手术部位感染（OR = 20.4，P < 0.001）、伤口裂开（OR = 19.08，P < 0.001）、术后肺炎（OR = 2.75，P = 0.01）、肺栓塞（OR = 15.39，P < 0.001）和进展性肾功能不全（OR = 10.13，P = 0.061）是 PCF 后再入院的显著预测因素。
确定 PCF 后再入院的预测因素可以改善患者咨询、识别高危患者，并指导医疗服务途径的改变。具有可改变的危险因素（如贫血和肾衰竭）的患者可能受益于术前优化。此外，术后并发症是一个关键的干预目标。
3 级。
