Shin John I, Kim Jun S, Steinberger Jeremy, DiCapua John, Cho Samuel K
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Clin Spine Surg. 2018 Feb;31(1):E55-E61. doi: 10.1097/BSD.0000000000000512.
This is retrospective study of prospectively collected data.
To identify patient factors that are independently associated with prolonged length of stay (LOS) and readmission after posterior cervical fusion (PCF) utilizing a large national database.
A number of studies have investigated the morbidity and mortality after PCF; however, little is known about the factors that are associated with prolonged LOS and readmission, both of which incur increased costs for patients and hospitals.
The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2014. Current Procedural Terminology code 22600 was used to identify patients who underwent PCF. All patient factors were assessed for association with LOS and readmission rate using bivariate and multivariate logistic regressions.
A total of 2667 patients who underwent PCF met the inclusion criteria for LOS analysis. Average (±SD) LOS was 3.92 (±3.24) days, and median LOS was 3 days (interquartile range, 2-5 d). On multivariate analysis, increased LOS was found to be significantly associated with dependent functional status (P<0.001), diabetes mellitus (P=0.021), preoperative anemia (P=0.001), American Society of Anesthesiologists class 3 or 4 (P<0.001), and number of fused levels (P<0.001). A total of 2591 patients met criteria (LOS≤11 d) for analysis of readmission. Readmission rate among these patients was 7.1%. Average (±SD) LOS of the patients not readmitted within 30 days of operation was 3.89 (±3.25), whereas the average (±SD) LOS of the patients readmitted was 4.24 (±3.08). On multivariate analysis, readmission was found to be significantly associated with only dependent functional status (P=0.019) and increased number of fused levels (P=0.032).
The current study provides valuable information on patient factors that are associated with prolonged LOS and readmission, which would be useful in enhanced informed consent before surgery, surgical planning, discharge planning, and optimizing postoperative care.
Level III.
这是一项对前瞻性收集数据的回顾性研究。
利用一个大型国家数据库，确定与颈椎后路融合术（PCF）后住院时间延长和再入院独立相关的患者因素。
多项研究调查了PCF后的发病率和死亡率；然而，对于与住院时间延长和再入院相关的因素知之甚少，这两者都会给患者和医院带来更高的费用。
查询了2011年至2014年美国外科医师学会国家外科质量改进计划数据库。使用当前手术操作术语代码22600来识别接受PCF的患者。使用双变量和多变量逻辑回归评估所有患者因素与住院时间和再入院率的相关性。
共有2667例接受PCF的患者符合住院时间分析的纳入标准。平均（±标准差）住院时间为3.92（±3.24）天，中位住院时间为3天（四分位间距，2 - 5天）。多变量分析显示，住院时间延长与依赖性功能状态（P<0.001）、糖尿病（P = 0.021）、术前贫血（P = 0.001）、美国麻醉医师协会3或4级（P<0.001）以及融合节段数（P<0.001）显著相关。共有2591例患者符合再入院分析标准（住院时间≤11天）。这些患者的再入院率为7.1%。术后30天内未再入院患者的平均（±标准差）住院时间为3.89（±3.25）天，而再入院患者的平均（±标准差）住院时间为4.24（±3.08）天。多变量分析显示，再入院仅与依赖性功能状态（P = 0.019）和融合节段数增加（P = 0.032）显著相关。
本研究提供了与住院时间延长和再入院相关的患者因素的有价值信息，这对于术前加强知情同意、手术规划、出院规划以及优化术后护理将是有用的。
三级。
