Sing David C, Berven Sigurd H, Burch Shane, Metz Lionel N
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA.
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA.
Spine J. 2017 May;17(5):627-635. doi: 10.1016/j.spinee.2016.11.005. Epub 2016 Nov 21.
Surgical treatment for adult spinal deformity improves patient quality of life; however, trends in surgical utilization in the elderly, who may be at higher risk for complications, remain unclear.
To identify trends in the utilization of adult deformity and determine complication rates among older patients.
This is a retrospective database analysis.
The Nationwide Inpatient Sample database was queried from 2004 to 2011 to identify adult patients who underwent spinal fusion of eight or more levels using International Classification of Diseases, Ninth Revision (ICD-9) coding.
Incidence of surgery, complication rates, length of stay, and total hospital charges.
The incidence of surgery was normalized to United States census data by age group. Trends in complications, length of stay, and inflation-adjusted hospital charges were determined using linear regression and Cochran-Armitage trend testing.
An estimated 29,237 patients underwent adult spinal deformity surgery with an increase from 2,137 to 5,030 cases per year from 2004 to 2011. Surgical incidence among patients 60 years and older increased from 1.9 to 6.5 cases per 100,000 people from 2004 to 2011 (p<.001), whereas utilization in patients younger than 60 increased from 0.59 to 0.93. Linear regression revealed that the largest increase in surgical utilization was for patients aged 65-69 years with an increase of 0.68 patients per 100,000 people per year (p<.001), followed by patients aged 70-74 years with a rate of 0.56 patients per 100,000 people per year (p=.001). Overall complication rates were 22.5% in 2004 and 26.7% in 2011. Although complication risk increased with age (≥60 vs. <60: relative risk 1.91 [1.83, 1.99], p<.001), within-age group rates were stable over time. Mean length of stay was 9.6 days in 2004 and 9.0 days in 2011. Inflation-adjusted mean hospital charges increased from $171,517 in 2004 to $303,479 in 2011 (p<.001).
Operative management of adult spinal deformity increased 3.4-fold among patients ≥60 years from 2004 to 2011, with an associated 1.8-fold increase in hospital charges. Although the exact reasons for the striking increase in hospital charges remain unclear, some of the increase is likely related to decreasing reimbursement of charges by payors over the same period of time. The large majority of cases were performed in large academic centers, and growth in deformity trained spine specialists in these centers may have contributed to this trend. Despite the increased utilization of surgery for adult spinal deformity, in-hospital complications remained stable across all ages.
成人脊柱畸形的手术治疗可改善患者生活质量；然而，老年患者（其并发症风险可能更高）的手术应用趋势仍不明确。
确定成人脊柱畸形手术的应用趋势，并确定老年患者的并发症发生率。
这是一项回顾性数据库分析。
查询2004年至2011年全国住院患者样本数据库，以识别使用国际疾病分类第九版（ICD - 9）编码进行八级或更多节段脊柱融合的成年患者。
手术发生率、并发症发生率、住院时间和住院总费用。
手术发生率按年龄组根据美国人口普查数据进行标准化。使用线性回归和 Cochr an - Armitage趋势检验确定并发症、住院时间和经通胀调整的住院费用的趋势。
估计有29237例患者接受了成人脊柱畸形手术，从2004年到2011年每年从2137例增加到5030例。60岁及以上患者的手术发生率从2004年的每10万人1.9例增加到2011年的6.5例（p <.001），而60岁以下患者的手术使用率从0.59增加到0.93。线性回归显示，手术使用率增加最多的是65 - 69岁的患者，每年每10万人增加0.68例（p <.001），其次是70 - 74岁的患者，每年每10万人增加0.56例（p =.001）。总体并发症发生率在2004年为22.5%，2011年为26.7%。尽管并发症风险随年龄增加（≥60岁与<60岁：相对风险1.91 [1.83, 1.99]，p <.001），但各年龄组内的发生率随时间保持稳定。2004年平均住院时间为9.6天，2011年为9.0天。经通胀调整的平均住院费用从2004年的171517美元增加到2011年的303479美元（p <.001）。
2004年至2011年，60岁及以上患者成人脊柱畸形的手术治疗增加了3.4倍，住院费用相应增加了1.8倍。尽管住院费用大幅增加的确切原因尚不清楚，但部分增加可能与同期付款人报销费用的减少有关。绝大多数病例在大型学术中心进行，这些中心脊柱畸形专科医生的增加可能促成了这一趋势。尽管成人脊柱畸形手术的使用率有所增加，但各年龄段的院内并发症保持稳定。
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