1998年至2011年美国立体定向放射治疗后住院患者入院情况的全国趋势及院内患者结局
National trends in inpatient admissions following stereotactic radiosurgery and the in-hospital patient outcomes in the United States from 1998 to 2011.
作者信息
Ho Allen L, Li Alexander Y, Sussman Eric S, Pendharkar Arjun V, Iyer Aditya, Thompson Patricia A, Tayag Armine T, Chang Steven D
机构信息
Department of Neurosurgery, Stanford School of Medicine, Stanford, CA 94305, USA.
Department of Neurosurgery, Stanford School of Medicine, Stanford, CA 94305, USA; Department of Radiation Oncology, Stanford School of Medicine, Stanford, CA 94305, USA.
出版信息
J Radiosurg SBRT. 2016;4(3):165-176.
PURPOSE
This study sought to examine trends in stereotactic radiosurgery (SRS) and in-hospital patient outcomes on a national level by utilizing national administrative data from the Nationwide Inpatient Sample (NIS) database.
METHODS AND MATERIALS
Using the NIS database, all discharges where patients underwent inpatient SRS were included in our study from 1998 - 2011 as designated by the ICD9-CM procedural codes. Trends in the utilization of primary and adjuvant SRS, in-hospital complications and mortality, and resource utilization were identified and analyzed.
RESULTS
Our study included over 11,000 hospital discharges following admission for primary SRS or for adjuvant SRS following admission for surgery or other indication. The most popular indication for SRS continues to be treatment of intracranial metastatic disease (36.7%), but expansion to primary CNS lesions and other non-malignant pathology beyond trigeminal neuralgia has occurred over the past decade. Second, inpatient admissions for primary SRS have declined by 65.9% over this same period of time. Finally, as inpatient admissions for SRS become less frequent, the complexity and severity of illness seen in admitted patients has increased over time with an increase in the average comorbidity score from 1.25 in the year 2002 to 2.29 in 2011, and an increase in over-all in-hospital complication rate of 2.8 times over the entire study period.
CONCLUSIONS
As the practice of SRS continues to evolve, we have seen several trends in associated hospital admissions. Overall, the number of inpatient admissions for primary SRS has declined while adjuvant applications have remained stable. Over the same period, there has been associated increase in complication rate, length of stay, and mortality in inpatients. These associations may be explained by an increase in the comorbidity-load of admitted patients as more high-risk patients are selected for admission at inpatient centers while more stable patients are increasingly being referred to outpatient centers.
目的
本研究旨在利用全国住院患者样本（NIS）数据库中的国家行政数据，在国家层面上研究立体定向放射外科（SRS）的趋势以及住院患者的结局。
方法与材料
使用NIS数据库，根据ICD9-CM程序编码，将1998年至2011年期间患者接受住院SRS治疗的所有出院病例纳入我们的研究。确定并分析了原发性和辅助性SRS的使用趋势、住院并发症和死亡率以及资源利用情况。
结果
我们的研究包括因原发性SRS入院或因手术或其他指征入院后接受辅助性SRS治疗后的11000多次医院出院病例。SRS最常见的指征仍然是颅内转移性疾病的治疗（36.7%），但在过去十年中，其应用已扩展到原发性中枢神经系统病变以及三叉神经痛以外的其他非恶性病变。其次，同期原发性SRS的住院入院率下降了65.9%。最后，随着SRS住院入院次数的减少，入院患者的疾病复杂性和严重程度随时间增加，平均合并症评分从2002年的1.25增加到2011年的2.29，在整个研究期间总体住院并发症发生率增加了2.8倍。
结论
随着SRS实践的不断发展，我们在相关医院入院情况中看到了几个趋势。总体而言，原发性SRS的住院入院次数减少，而辅助性应用保持稳定。在同一时期，住院患者的并发症发生率、住院时间和死亡率有所增加。这些关联可能是由于入院患者的合并症负担增加，因为更多高危患者被选入住院中心住院，而越来越多病情稳定的患者被转诊到门诊中心。
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