纽约州腰椎融合术的应用：趋势与差异
Utilization of Lumbar Spinal Fusion in New York State: Trends and Disparities.
作者信息
Jancuska Jeffrey M, Hutzler Lorraine, Protopsaltis Themistocles S, Bendo John A, Bosco Joseph
机构信息
New York University School of Medicine, New York, NY.
Department of Orthopedic Surgery, New York University Hospital for Joint Diseases, New York, NY.
出版信息
Spine (Phila Pa 1976). 2016 Oct 1;41(19):1508-1514. doi: 10.1097/BRS.0000000000001567.
STUDY DESIGN
Retrospective review of an administrative database.
OBJECTIVE
To observe New York statewide trends in lumbar spine surgery and to compare utilization of fusion according to hospital size and patient population.
SUMMARY OF BACKGROUND DATA
Over the last 30 years, studies have indicated increasing rates of spinal fusion procedures performed each year in the United States. There is no study investigating potential variability in this trend according to hospital volume.
METHODS
New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 228,882 lumbar spine surgery patients. New York State hospitals were categorized as low-, medium-, or high-volume and descriptive statistics were used to determine trends in spinal fusion.
RESULTS
The number of fusions per year increased 55% from 2005 to 2014. The ratio of fusion to nonfusion surgery increased from 0.88 to 2.67 at high-volume, from 0.84 to 2.30 at medium- volume, and from 0.66 to 1.52 at low-volume hospitals. In 2014, 22% of spine surgery patients at low-volume hospitals were either African Americans or Hispanics compared with 12% and 14% at high- and medium-volume hospitals, respectively. At high-volume hospitals, 33% of patients were privately insured and 3% had Medicare compared with 30% and 6% at low-volume hospitals.
CONCLUSION
The annual number of lumbar spinal fusions continues to increase, especially at high- and medium-volume hospitals. The percentage of patients treated surgically for lumbar spinal stenosis that undergoes fusion ranges from 53.2 to 66.4% depending on hospital volume. Individual surgeon opinion, patient disease characteristics, and socioeconomic factors may affect surgical decision making. Caucasians and private insurance patients most often receive care at high-volume hospitals. Minorities and patients with Medicaid are over-represented at low-volume centers where fusions are less often performed. Accessibility to care at high-volume centers remains a major concern for these vulnerable populations.
LEVEL OF EVIDENCE
研究设计
对行政数据库进行回顾性研究。
目的
观察纽约州腰椎手术的全州趋势，并根据医院规模和患者群体比较融合手术的利用率。
背景数据总结
在过去30年中，研究表明美国每年进行的脊柱融合手术率不断上升。尚无研究调查根据医院手术量这一趋势的潜在差异。
方法
使用纽约州全州规划与研究合作系统（SPARCS）的行政数据来识别228,882例腰椎手术患者。纽约州的医院被分为低、中、高手术量三类，并使用描述性统计来确定脊柱融合的趋势。
结果
从2005年到2014年，每年的融合手术数量增加了55%。高手术量医院的融合手术与非融合手术的比例从0.88增至2.67，中等手术量医院从0.84增至2.30，低手术量医院从0.66增至1.52。2014年，低手术量医院脊柱手术患者中有22%为非裔美国人或西班牙裔，而高手术量和中等手术量医院分别为12%和14%。在高手术量医院，33%的患者为私人保险，3%为医疗保险，而低手术量医院分别为30%和6%。
结论
腰椎融合手术的年度数量持续增加，尤其是在高手术量和中等手术量医院。根据医院手术量，接受腰椎管狭窄症手术治疗并进行融合的患者比例在53.2%至66.4%之间。个体外科医生的意见、患者疾病特征和社会经济因素可能会影响手术决策。白人和私人保险患者最常在高手术量医院接受治疗。少数族裔和医疗补助患者在低手术量中心的占比过高，而这些中心较少进行融合手术。对于这些弱势群体而言，高手术量中心的医疗可及性仍是一个主要问题。
证据级别
3级。
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