De la Garza-Ramos Rafael, Goodwin C Rory, Abu-Bonsrah Nancy, Jain Amit, Miller Emily K, Neuman Brian J, Protopsaltis Themistocles S, Passias Peter G, Sciubba Daniel M
Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 5-185, Baltimore, MD 21287, USA.
Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Clin Neurosci. 2016 Sep;31:137-41. doi: 10.1016/j.jocn.2016.02.017. Epub 2016 May 24.
Prolonged length of stay (PLOS) has been associated with increased hospital resource utilization and worsened patient outcomes in multiple studies. In this study, we defined and identified factors associated with PLOS after posterior surgery for cervical spondylotic myelopathy in patients over the age of 65. PLOS was defined as length of stay beyond the "prolongation point" (that is, the day after which discharge rates begin to decline). Using the United States Nationwide Inpatient Sample database, 2742 patients met inclusion criteria, out of whom 16.5% experienced PLOS (stay beyond 6days). After multivariate analysis, increasing age was independently associated with PLOS (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.06). Multiple comorbid conditions were associated with PLOS, including alcohol abuse (OR 3.85, 95% CI 1.87-7.94), congestive heart failure (OR 1.72, 95% CI 1.11-2.64), obesity (OR 1.70, 95% CI 1.14-2.55), and deficiency anemia (OR 1.44, 95% CI 1.01-2.05); the strongest associated operative parameter was blood transfusion (OR 2.39, 95% CI 1.75-3.28). Major complications independently associated with PLOS were deep vein thrombosis (OR 18.32, 95% CI 6.50-51.61), myocardial infarction (OR 8.98, 95% CI 2.92-27.56), pneumonia (OR 6.67, 95% CI 3.17-14.05), acute respiratory failure (OR 6.27, 95% CI 3.43-11.45), hemorrhage/hematoma (OR 5.04, 95% CI 2.69-9.44), and implant-related complications (OR 2.49, 95% CI 1.24-4.98). Average total hospital charges for patients who experienced PLOS were $122,965 US dollars, compared to $76,870 for the control group (p<0.001). Mortality for patients who experienced PLOS was 2.7% versus 0.5% for patients who did not epxerience PLOS (p<0.001). In conclusion, patients over the age of 65 who underwent posterior surgery for cervical myelopathy and stayed over 6days in hospital were defined as having PLOS. Hospital charges and mortality rates were significantly higher for patients who experienced PLOS. Potentially modifiable and/or preventable risk factors were also identified.
多项研究表明，住院时间延长（PLOS）与医院资源利用增加及患者预后恶化相关。在本研究中，我们对65岁以上脊髓型颈椎病患者后路手术后与PLOS相关的因素进行了定义和识别。PLOS被定义为超过“延长点”（即出院率开始下降后的第一天）的住院时间。利用美国全国住院样本数据库，2742例患者符合纳入标准，其中16.5%经历了PLOS（住院时间超过6天）。多因素分析后，年龄增长与PLOS独立相关（比值比[OR]为1.04，95%置信区间[CI]为1.02 - 1.06）。多种合并症与PLOS相关，包括酒精滥用（OR 3.85，95% CI 1.87 - 7.94）、充血性心力衰竭（OR 1.72，95% CI 1.11 - 2.64）、肥胖（OR 1.70，95% CI 1.14 - 2.55）和缺铁性贫血（OR 1.44，95% CI 1.01 - 2.05）；最强相关的手术参数是输血（OR 2.39，95% CI 1.75 - 3.28）。与PLOS独立相关的主要并发症有深静脉血栓形成（OR 18.32，95% CI 6.50 - 51.61）、心肌梗死（OR 8.98，95% CI 2.92 - 27.56）、肺炎（OR 6.67，95% CI 3.17 - 14.05）、急性呼吸衰竭（OR 6.27，95% CI 3.43 - 11.45）、出血/血肿（OR 5.04，95% CI 2.69 - 9.44）和植入物相关并发症（OR 2.49，95% CI 1.24 - 4.98）。经历PLOS的患者平均总住院费用为122,965美元，而对照组为76,870美元（p<0.001）。经历PLOS的患者死亡率为2.7%，未经历PLOS的患者死亡率为0.5%（p<0.001）。总之，65岁以上接受脊髓型颈椎病后路手术且住院超过6天的患者被定义为有PLOS。经历PLOS的患者住院费用和死亡率显著更高。还识别出了潜在可改变和/或可预防的风险因素。
