择期 Medicare 脊柱融合手术的住院和 90 天出院后结局。

Inpatient and 90-day post-discharge outcomes in elective Medicare spine fusion surgery.

机构信息

MPA Healthcare Solutions, 1 East Wacker Dr., #2850, Chicago, IL, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA.

MPA Healthcare Solutions, 1 East Wacker Dr., #2850, Chicago, IL, USA; Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

出版信息

Spine J. 2017 Nov;17(11):1641-1649. doi: 10.1016/j.spinee.2017.05.026. Epub 2017 Jun 27.

DOI:10.1016/j.spinee.2017.05.026

PMID:28662991

Abstract

BACKGROUND CONTEXT

Elective spine surgery is a commonly performed operative procedure, that requires knowledge of risk-adjusted results to improve outcomes and reduce costs.

PURPOSE

To develop risk-adjusted models to predict the adverse outcomes (AOs) of care during the inpatient and 90-day post-discharge period for spine fusion surgery.

STUDY DESIGN/SETTING: To identify the significant risk factors associated with AOs and to develop risk models that measure performance.

PATIENT SAMPLE

Hospitals that met minimum criteria of both 20 elective cervical and 20 elective non-cervical spine fusion operations in the 2012-2014 Medicare limited dataset.

OUTCOME MEASURES

The risk-adjusted AOs of inpatient deaths, prolonged length-of-stay for the index hospitalization, 90-day post-discharge deaths, and 90-day post-discharge readmissions were dependent variables in predictive risk models.

METHODS

Over 500 candidate risk factors were used for logistic regression models to predict the AOs. Models were then used to predicted risk-adjusted AO rates by hospitals.

RESULTS

There were 874 hospitals with a minimum of both 20 cervical and 20 non-cervical spine fusion patients. There were 167,395 total cases. A total of 7,981 (15.9%) of cervical fusion patients and 17,481 (14.9%) of non-cervical fusion patients had one or more AOs for an overall AO rate of 15.2%. A total of 54 hospitals (6.2%) had z-scores that were 2.0 better than predicted with a median risk adjusted AO rate of 9.2%, and 75 hospitals (8.6%) were 2.0 z-scores poorer than predicted with a median risk-adjusted AO rate of 23.2%.

CONCLUSIONS

Differences among hospitals defines opportunities for care improvement.

摘要

背景语境

择期脊柱手术是一种常见的手术操作，需要了解风险调整后的结果，以改善结果并降低成本。

目的

开发风险调整模型，以预测脊柱融合手术后住院期间和出院后 90 天内的不良结果（AO）。

研究设计/设置：确定与 AO 相关的显著风险因素，并开发衡量绩效的风险模型。

患者样本

符合 Medicare 有限数据集 2012-2014 年 20 例选择性颈椎和 20 例非颈椎脊柱融合手术最低标准的医院。

结果测量

住院期间死亡、指数住院期间延长住院时间、出院后 90 天内死亡和出院后 90 天内再次入院的风险调整 AO 是预测风险模型中的因变量。

方法

使用超过 500 个候选风险因素进行逻辑回归模型，以预测 AO。然后使用模型预测医院的风险调整 AO 率。

结果

共有 874 家医院至少有 20 例颈椎和 20 例非颈椎脊柱融合患者。共有 167395 例总病例。共有 7981 例（15.9%）颈椎融合患者和 17481 例（14.9%）非颈椎融合患者出现 1 个或多个 AO，总体 AO 发生率为 15.2%。共有 54 家医院（6.2%）的 z 分数比预测值高 2.0，中位数风险调整 AO 率为 9.2%，75 家医院（8.6%）的 z 分数比预测值低 2.0，中位数风险调整 AO 率为 23.2%。