脊髓型颈椎病患者住院时间和30天再入院的预测因素：使用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库对3057例患者的分析
Predictors of Hospital Length of Stay and 30-Day Readmission in Cervical Spondylotic Myelopathy Patients: An Analysis of 3057 Patients Using the ACS-NSQIP Database.
作者信息
Passias Peter G, Jalai Cyrus M, Worley Nancy, Vira Shaleen, Hasan Saqib, Horn Samantha R, Segreto Frank A, Bortz Cole A, White Andrew P, Gerling Michael, LaFage Virginie, Errico Thomas
机构信息
Division of Spinal Surgery, Department of Orthopaedic Surgery and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital-NYU School of Medicine-NY Spine Institute, New York, New York, USA.
Division of Spinal Surgery, Department of Orthopaedic Surgery and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital-NYU School of Medicine-NY Spine Institute, New York, New York, USA.
出版信息
World Neurosurg. 2018 Feb;110:e450-e458. doi: 10.1016/j.wneu.2017.11.009. Epub 2017 Nov 14.
BACKGROUND
Hospital length of stay (LOS), 30-day readmission rate, and other metrics are increasingly being used to evaluate quality of surgical care. The factors most relevant to cervical spondylotic myelopathy (CSM) are not yet established.
OBJECTIVE
To identify perioperative factors associated with extended LOS and 30-day readmission following elective surgery for CSM.
METHODS
Surgical CSM patients at institutions represented by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) during 2010-2012 were included. Patients with fracture, 9 or more levels fused, or cancer were excluded. Extended LOS was defined as 75th percentile of the cohort. Univariate analysis and multivariate logistic regression identified predictors for extended LOS, 30-day readmission, and reoperation. Linear regression modeling was used to evaluate variables.
RESULTS
Three thousand fifty-seven surgical CSM cases were isolated. Age (odds ratio [OR], 1.496), diabetes (OR, 1.691), American Society of Anesthesiologists (ASA) class (OR, 2.081), posterior surgical approach (OR, 2.695), and operative time (OR, 1.008) were all positive predictors (P < 0.05) for extended LOS (≥4 days). Thirty-two percent of the cohort (976 patients) had 30-day readmission data. Among these, 915 patients were not readmitted (93.8%), while 61 (6.2%) were readmitted. Diabetes (OR, 1.460) and ASA class (OR, 2.539) were significant positive predictors for hospital readmission. Age (OR, 0.918) was a negative predictor of re-operation in readmitted patients, and pulmonary comorbidities (OR, 4.584) were a positive predictor (P < 0.05).
CONCLUSIONS
Patients with diabetes and higher ASA class were at increased risk for extended LOS and readmission within 30-days. Patients with increased operative time have greater risk for extended LOS. Preoperative pulmonary comorbidities increased reoperation risk, whereas increased age reduced the risk. Attention to these factors may benefit CSM patients.
背景
住院时间（LOS）、30天再入院率及其他指标越来越多地用于评估外科治疗质量。与脊髓型颈椎病（CSM）最相关的因素尚未确定。
目的
确定与择期CSM手术后住院时间延长和30天再入院相关的围手术期因素。
方法
纳入2010 - 2012年期间由美国外科医师学会国家外科质量改进计划（ACS - NSQIP）代表的机构中的手术治疗CSM患者。排除有骨折、融合9个或更多节段或患有癌症的患者。住院时间延长定义为队列的第75百分位数。单因素分析和多因素逻辑回归确定住院时间延长、30天再入院和再次手术的预测因素。使用线性回归模型评估变量。
结果
分离出3057例手术治疗的CSM病例。年龄（比值比[OR]，1.496）、糖尿病（OR，1.691）、美国麻醉医师协会（ASA）分级（OR，2.081）、后路手术方式（OR，2.695）和手术时间（OR，1.008）均为住院时间延长（≥4天）的阳性预测因素（P < 0.05）。队列中的32%（976例患者）有30天再入院数据。其中，915例患者未再入院（93.8%），而61例（6.2%）再入院。糖尿病（OR，1.460）和ASA分级（OR，2.539）是医院再入院的显著阳性预测因素。年龄（OR，0.918）是再入院患者再次手术的阴性预测因素，而肺部合并症（OR，4.584）是阳性预测因素（P < 0.05）。
结论
患有糖尿病和ASA分级较高的患者住院时间延长和30天内再入院的风险增加。手术时间延长的患者住院时间延长的风险更大。术前肺部合并症增加再次手术风险，而年龄增加则降低风险。关注这些因素可能使CSM患者受益。
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