Garcia Roxanna M, Khanna Ryan, Dahdaleh Nader S, Cybulski George, Lam Sandi, Smith Zachary A
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Global Spine J. 2017 May;7(3):220-226. doi: 10.1177/2192568217694144. Epub 2017 Apr 20.
Retrospective cohort study.
To describe the readmission rate and identify risk factors associated with 30-day readmission after transforaminal lumbar interbody fusion (TLIF) surgery.
Patients who underwent elective single level TLIF surgery from 2011 to 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Emergency or trauma cases were excluded. Preoperative, intraoperative, and postoperative variables were extracted. A multivariate binary regression identified predictors correlated with 30-day readmission.
A total of 4992 patients were included in the analysis. The overall 30-day readmission rate was 5.51% (275/4992) for readmissions reported between 2011 to 2013. The mean age of patients readmitted was 62.40 years (standard error [SE] = 0.78) and 60.92 years (SE = 0.20) among those whom were not readmitted ( = .05). The top three causes for readmission included postoperative pain control, deep or superficial surgical site infections. Predictors associated with 30-day readmission in a multivariate analysis included female gender (odds ratio [OR] = 1.27, 95% CI = 0.97-1.65), history of severe chronic obstructive pulmonary disease (OR = 1.81, 95% CI = 1.11-2.96), and in the postoperative period, American Society of Anesthesiologists class (OR = 1.30, 95% CI = 1.04-1.63), presence of superficial surgical site infection (OR= 18.23, 95% CI = 10.36-32.08), or urinary tract infection (OR = 4.93, 95% CI = 2.84-8.58).
The readmission rate, risk factors, and causes following TLIF surgery are comparable to other lumbar spinal procedures reported from the ACS-NSQIP database.
回顾性队列研究。
描述经椎间孔腰椎椎体间融合术（TLIF）手术后的再入院率，并确定与30天再入院相关的危险因素。
在美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库中识别出2011年至2013年接受择期单节段TLIF手术的患者。排除急诊或创伤病例。提取术前、术中和术后变量。多变量二元回归确定与30天再入院相关的预测因素。
共有4992例患者纳入分析。2011年至2013年报告的再入院患者中，总体30天再入院率为5.51%（275/4992）。再入院患者的平均年龄为62.40岁（标准误[SE]=0.78），未再入院患者的平均年龄为60.92岁（SE=0.20）（P = 0.05）。再入院的三大原因包括术后疼痛控制、深部或浅部手术部位感染。多变量分析中与30天再入院相关的预测因素包括女性（比值比[OR]=1.27，95%置信区间[CI]=0.97-1.65）、严重慢性阻塞性肺疾病史（OR=1.81，95%CI=1.11-2.96），以及术后美国麻醉医师协会分级（OR=1.30，95%CI=1.04-1.63）、浅部手术部位感染（OR=18.23，95%CI=10.36-32.08）或尿路感染（OR=4.93，95%CI=2.84-8.58）。
TLIF手术后的再入院率、危险因素和原因与ACS-NSQIP数据库报告的其他腰椎手术相当。
