Radcliff Kris, Ong Kevin L, Lovald Scott, Lau Edmund, Kurd Mark
Rothman Institute, Egg Harbor Township, NJ.
Exponent, Philadelphia, PA.
Spine (Phila Pa 1976). 2017 Mar 15;42(6):E347-E354. doi: 10.1097/BRS.0000000000001799.
Cervical decompression (CD) and cervical fusion (CF) patients in 5% Medicare Part B claims data.
Evaluate the complication rate and associated risk factors after cervical spine surgery using a national sample of elderly patients.
The number of cervical spine procedures in the United States has risen along with associated hospital costs. Postoperative complications lead to longer hospitalizations and greater costs.
Demographic information and postoperative complications (90 days) were evaluated. Multivariate Cox regression was used to evaluate the risk factors for the complications, while adjusting for age, socioeconomic status, Charlson comorbidity index, race, census region, sex, and year of surgery.
Between 2010 and 2012, 1519 CD and 1273 CF Medicare patients were identified in the dataset. Respiratory complications (CD: 12.1% and CF: 14.6%), urinary retention (CD: 8.2% and CF: 9.1%), acute delirium (CD: 5.3% and CF: 6.0%), and nausea/vomiting (CD: 2.8% and CF: 3.1%) were the most commonly diagnosed complications. All other complications had an incidence of less than 1.5%. Older patients had higher risks of respiratory complications for both procedures, and CD patients with Charlson scores of 1 to 2 and 5+ were also at higher risk of respiratory complications. Males (P <0.001) were at higher risk of urinary retention. Patients with dementia (P <0.001) had a higher risk of acute delirium after both CD and CF. For CD patients, those aged 85 years and over had higher risk of acute delirium, along with patients with transient ischemic attack/stroke. Age was also a significant risk factor (P = 0.019) for acute delirium for CF patients. Females were at a significantly higher risk of nausea/vomiting after CD and CF.
These data help to provide baseline information regarding the complication rates in the elderly CD and CF patient population in the United States, and will serve to help minimize these complications.
利用5%的医疗保险B部分索赔数据中的颈椎减压（CD）和颈椎融合（CF）患者。
使用老年患者的全国样本评估颈椎手术后的并发症发生率及相关风险因素。
美国颈椎手术的数量随着相关医院费用的增加而上升。术后并发症导致住院时间延长和费用增加。
评估人口统计学信息和术后并发症（90天内）。采用多变量Cox回归评估并发症的风险因素，同时对年龄、社会经济地位、Charlson合并症指数、种族、人口普查地区、性别和手术年份进行调整。
在2010年至2012年期间，数据集中识别出1519例CD医疗保险患者和1273例CF医疗保险患者。呼吸并发症（CD：12.1%，CF：14.6%）、尿潴留（CD：8.2%，CF：9.1%）、急性谵妄（CD：5.3%，CF：6.0%）和恶心/呕吐（CD：2.8%，CF：3.1%）是最常诊断出的并发症。所有其他并发症的发生率均低于1.5%。老年患者在两种手术中发生呼吸并发症的风险更高，Charlson评分为1至2分和5分以上的CD患者发生呼吸并发症的风险也更高。男性（P<0.001）发生尿潴留的风险更高。痴呆患者（P<0.001）在CD和CF后发生急性谵妄的风险更高。对于CD患者，85岁及以上的患者以及短暂性脑缺血发作/中风患者发生急性谵妄的风险更高。年龄也是CF患者急性谵妄的一个重要风险因素（P=0.019）。女性在CD和CF后发生恶心/呕吐的风险显著更高。
这些数据有助于提供关于美国老年CD和CF患者人群并发症发生率的基线信息，并将有助于尽量减少这些并发症。
3级。
