Yuk Frank J, Maniya Akbar Y, Rasouli Jonathan J, Dessy Alexa M, McCormick Patrick J, Choudhri Tanvir F
Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center.
Anesthesiology, Memorial Sloan-Kettering Cancer Center.
Cureus. 2017 Jul 10;9(7):e1452. doi: 10.7759/cureus.1452.
Background Disease of the cervical spine is widely prevalent, most commonly secondary to degenerative disc changes and spondylosis. Objective The goal of the paper was to identify a possible discrepancy regarding the length of stay (LOS) between the anterior and posterior approaches to elective cervical spine surgery and identify contributing factors. Methods A retrospective study was performed on 587 patients (341 anterior, 246 posterior) that underwent elective cervical spinal surgery between October 2001 and March 2014. Pre- and intraoperative data were analyzed. Statistical analysis was performed using GraphPad Prism 5 (GraphPad Software, Inc., La Jolla, CA) and the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY). Results Average LOS was 3.21 ± 0.32 days for patients that benefited from the anterior approach cervical spinal surgery and 5.28 ± 0.37 days for patients that benefited from the posterior approach surgery, P-value < 0.0001. Anterior patients had lower American Society of Anesthesiologists scores (2.43 ± 0.036 vs. 2.70 ± 0.044). Anterior patients also had fewer intervertebral levels operated upon (2.18 ± 0.056 vs. 4.11 ± 0.13), shorter incisions (5.49 ± 0.093 cm vs. 9.25 ± 0.16 cm), lower estimated blood loss (EBL) (183.8 ± 9.0 cc vs. 340.0 ± 8.7 cc), and shorter procedure times (4.12 ± 0.09 hours vs. 4.47 ± 0.10 hours). Chi-squared tests for hypertension, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and asthma showed no significant difference between groups.
Patients with anterior surgery performed experienced a length of stay that was 2.07 days shorter on average. Higher EBL, longer incisions, more intervertebral levels, and longer operating time were significantly associated with the posterior approach. Future studies should include multiple surgeons. The goal would be to create a model that could accurately predict the postoperative length of stay based on patient and operative factors.
背景 颈椎疾病广泛流行，最常见的是继发于椎间盘退变和脊柱关节病。目的 本文的目的是确定选择性颈椎手术前后路手术住院时间（LOS）可能存在的差异，并确定相关因素。方法 对2001年10月至2014年3月期间接受选择性颈椎手术的587例患者（前路341例，后路246例）进行回顾性研究。分析术前和术中数据。使用GraphPad Prism 5（GraphPad软件公司，加利福尼亚州拉霍亚）和社会科学统计软件包（SPSS）（IBM SPSS Statistics，纽约州阿蒙克）进行统计分析。结果 接受前路颈椎手术的患者平均住院时间为3.21±0.32天，接受后路手术的患者平均住院时间为5.28±0.37天，P值<0.0001。前路手术患者的美国麻醉医师协会评分较低（2.43±0.036对2.70±0.044）。前路手术患者的手术节段也较少（2.18±0.056对4.11±0.13），切口较短（5.49±0.093 cm对9.25±0.16 cm），估计失血量（EBL）较低（183.8±9.0 cc对340.0±8.7 cc），手术时间较短（4.12±0.09小时对4.47±0.10小时）。对高血压、冠状动脉疾病、充血性心力衰竭、慢性阻塞性肺疾病和哮喘进行的卡方检验显示两组之间无显著差异。
接受前路手术的患者平均住院时间短2.07天。较高的EBL、较长的切口、更多的椎间节段和较长的手术时间与后路手术显著相关。未来的研究应纳入多名外科医生。目标是建立一个能够根据患者和手术因素准确预测术后住院时间的模型。
