国家行政数据库在成人脊柱畸形手术中的应用：一个警示故事。
National Administrative Databases in Adult Spinal Deformity Surgery: A Cautionary Tale.
机构信息
Division of Spine Surgery, Department of Orthopedic Surgery, Hospital for Joint Diseases, New York University Langone Medical Center, Spine Research Center, New York, NY.
Division of Orthopedic Surgery, University of California Davis, Sacramento, CA.
出版信息
Spine (Phila Pa 1976). 2017 Aug 15;42(16):1248-1254. doi: 10.1097/BRS.0000000000002064.
STUDY DESIGN
Comparison between national administrative databases and a prospective multicenter physician managed database.
OBJECTIVES
This study aims to assess the applicability of National Administrative Databases (NADs) in adult spinal deformity (ASD). Our hypothesis is that NADs do not include comparable patients as in a physician-managed database (PMD) for surgical outcomes in adult spinal deformity.
SUMMARY OF BACKGROUND DATA
NADs such as National Inpatient Sample (NIS) and National Surgical Quality Improvement Program (NSQIP) provide large numbers of publications owing to ease of data access and lack of IRB approval requirement. These databases utilize billing codes, not clinical inclusion criteria, and have not been validated against PMDs in ASD surgery.
METHODS
The NIS was searched for years 2002 to 2012 and NSQIP for years 2006 to 2013 using validated spinal deformity diagnostic codes. Procedural codes (ICD-9 and CPT) were then applied to each database. A multicenter PMD including years 2008 to 2015 was used for comparison. Databases were assessed for levels fused, osteotomies, decompressed levels, and invasiveness. Database comparisons for surgical details were made in all patients, and also for patients with ≥ 5 level spinal fusions.
RESULTS
Approximately, 37,368 NIS, 1291 NSQIP, and 737 PMD patients were identified. NADs showed an increased use of deformity billing codes over the study period (NIS doubled, 68x NSQIP, P < 0.001), but ASD remained stable in the PMD.Surgical invasiveness, levels fused and use of 3-column osteotomy (3-CO) were significantly lower for all patients in the NIS (11.4-13.7) and NSQIP databases (6.4-12.7) compared with PMD (27.5-32.3). When limited to patients with ≥5 levels, invasiveness, levels fused, and use of 3-CO remained significantly higher in the PMD compared with NADs (P < 0.001).
CONCLUSION
National databases NIS and NSQIP do not capture the same patient population as is captured in PMDs in ASD. Physicians should remain cautious in interpreting conclusions drawn from these databases.
LEVEL OF EVIDENCE
研究设计
国家行政数据库与前瞻性多中心医生管理数据库的比较。
目的
本研究旨在评估国家行政数据库（NAD）在成人脊柱畸形（ASD）中的适用性。我们的假设是，NAD 不包括与医生管理数据库（PMD）中可比的患者，无法用于评估成人脊柱畸形的手术结果。
背景资料概要
国家住院患者样本（NIS）和国家手术质量改进计划（NSQIP）等 NAD 由于易于获取数据且无需获得 IRB 批准，因此提供了大量出版物。这些数据库使用计费代码，而不是临床纳入标准，并且尚未在 ASD 手术中经过 PMD 的验证。
方法
使用经过验证的脊柱畸形诊断代码，在 2002 年至 2012 年期间在 NIS 中进行搜索，并在 2006 年至 2013 年期间在 NSQIP 中进行搜索。然后将程序代码（ICD-9 和 CPT）应用于每个数据库。使用 2008 年至 2015 年的多中心 PMD 进行比较。评估数据库融合的水平、截骨术、减压水平和侵袭性。在所有患者中比较数据库手术细节，以及在融合≥5 个脊柱水平的患者中比较数据库手术细节。
结果
NIS 中约有 37368 例，NSQIP 中有 1291 例，PMD 中有 737 例。NAD 中在研究期间使用畸形计费代码的比例增加（NIS 增加了一倍，是 NSQIP 的 68 倍，P<0.001），但 PMD 中的 ASD 保持稳定。在 NIS（11.4-13.7）和 NSQIP 数据库（6.4-12.7）中，所有患者的手术侵袭性、融合水平和使用 3 柱截骨术（3-CO）均明显低于 PMD（27.5-32.3）。当仅限于融合≥5 个脊柱水平的患者时，与 NAD 相比，PMD 中的侵袭性、融合水平和使用 3-CO 仍然明显更高（P<0.001）。
结论
NIS 和 NSQIP 等国家数据库并未捕获到与 ASD 中 PMD 中相同的患者人群。医生在解释从这些数据库得出的结论时应保持谨慎。
证据水平
4 级。
Zotero 插件