Poorman Gregory W, Passias Peter G, Buckland Aaron J, Jalai Cyrus M, Kelly Michael, Sciubba Daniel M, Neuman Brian J, Hamilton D Kojo, Jain Amit, Diebo Bassel, Lafage Virginie, Bess Shay, Klineberg Eric O
Department of Orthopaedic Surgery at NYU Hospital for Joint Diseases, New York, NY.
Department of Orthopaedic Surgery at Washington University School of Medicine, St. Louis, MO.
Spine (Phila Pa 1976). 2017 Aug 1;42(15):1165-1171. doi: 10.1097/BRS.0000000000002002.
Retrospective analysis of three prospectively collected databases.
To compare perioperative outcomes in Adult Spinal Deformity (ASD) surgeries in a surgeon-run (SR-ASD) and two national databases: the Nationwide Inpatient Sample (NIS) and the National Surgical Quality Improvement Program (NSQIP).
Much has been learned on the treatment of ASD in the last decade with prospective multicenter collaborative research focusing on this specific condition. Nondisease specific national databases are being used for hypothesis and quality control testing on a large number of ASD patients. Their accuracy and applicability remains unevaluated.
Patients were identified on each respective database undergoing lumbar spine fusion for ASD. Propensity score matching established cohorts of patients on each database with similar procedures being performed. Complication prevalence and relative risk was compared on the NIS and NSQIP against SR-ASD. Secondary outcome measures included hospital-stay characteristics, surgical invasiveness, patient demographics, and patient comorbidities.
Two hundred fifty-five patients were identified on each database 1:1:1 with similar overall surgical intensity. Querying the databases using ICD-9 codes, CPT codes, and surgeon-reports resulted in different complication incidences: overall complication rates were 17.65% on NIS, 24.31% on NSQIP, and 68.24% on SR-ASD. The relative risk of a medical complication in SR-ASD was 1.87 (1.42-2.48) relative to NIS and 1.91 (1.44-2.54) relative to NSQIP. The relative risk of a surgical complication was 5.45 (2.69-11.05) compared with NIS and 12.05 (3.98-36.49) compared with NSQIP.
After selecting patients using the same criteria and diagnosis, NIS, NSQIP, and SR-ASD databases captured different patient populations and different complication incidences. There were total absences of certain complications contrary to usual literature rates in all three databases. Faithful reporting necessitates understanding database limitations, and careful evaluation of database strengths and weaknesses is paramount to accurate reports.
对三个前瞻性收集的数据库进行回顾性分析。
比较在外科医生主导的成人脊柱畸形（ASD）手术（SR-ASD）与两个全国性数据库（全国住院患者样本（NIS）和国家外科质量改进计划（NSQIP））中的围手术期结果。
在过去十年中，通过针对这一特定病症的前瞻性多中心合作研究，人们对ASD的治疗有了很多了解。非疾病特异性的全国性数据库正被用于对大量ASD患者进行假设和质量控制测试。但其准确性和适用性仍未得到评估。
在每个各自的数据库中识别接受ASD腰椎融合手术的患者。倾向评分匹配在每个数据库中建立了进行类似手术的患者队列。将NIS和NSQIP中的并发症发生率和相对风险与SR-ASD进行比较。次要结局指标包括住院特征、手术侵袭性、患者人口统计学和患者合并症。
在每个数据库中均识别出255例患者，三者手术强度总体相似。使用ICD-9编码、CPT编码和外科医生报告查询数据库得出了不同的并发症发生率：NIS上的总体并发症发生率为17.65%，NSQIP上为24.31%，SR-ASD上为68.24%。相对于NIS，SR-ASD发生医疗并发症的相对风险为1.87（1.42 - 2.48），相对于NSQIP为1.91（1.44 - 2.54）。与NIS相比，手术并发症的相对风险为5.45（2.69 - 11.05），与NSQIP相比为12.05（3.98 - 36.49）。
在使用相同标准和诊断选择患者后，NIS、NSQIP和SR-ASD数据库捕获了不同的患者群体和不同的并发症发生率。在所有三个数据库中，某些并发症的发生率与通常文献报道的发生率完全不同。如实报告需要了解数据库的局限性，仔细评估数据库的优缺点对于准确报告至关重要。
3级。
