Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT 06510, USA.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT 06510, USA.
Spine J. 2018 Jul;18(7):1188-1196. doi: 10.1016/j.spinee.2017.11.011. Epub 2017 Nov 16.
There has been growing interest in performing posterior lumbar fusions (PLFs) in the outpatient setting to optimize patient satisfaction and reduce cost. Although still done in only a small percentage of cases, this has been more possible because of advances in surgical techniques and anesthesia. However, data on the perioperative course of outpatient compared with inpatient PLF in a large sample size are scarce.
This study aimed to compare perioperative complications between outpatient and inpatient PLF in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
STUDY DESIGN/SETTING: A retrospective cohort comparison study was carried out.
Patients undergoing PLF with or without interbody fusion from the 2005 to 2015 NSQIP database comprised the sample.
Outcome measures were postoperative complications within 30 days and readmission within 30 days.
Patients who underwent PLF with or without interbody fusion were identified in the 2005-2015 NSQIP database. Outpatient procedures were defined as cases that had hospital length of stay (LOS)=0 days, whereas inpatient procedures were defined as LOS=1-30 days. Patient characteristics, comorbidities, and procedural variables (inclusion of interbody fusion, instrumentation, and number of levels fused) were compared between the two cohorts. Propensity score-matched comparisons were then performed for postoperative complications and 30-day readmissions between the two groups.
The current study included 360 outpatient and 36,610 inpatient PLF cases. After propensity matching to control potential confounding factors, statistical analysis revealed no significant difference in postoperative adverse events other than significantly lower blood transfusions in the outpatient group (2.78% vs. 10.83%, p<.001). Notably, the rate of readmissions was not different between the groups.
Based on the lack of differences in rates of most perioperative complications and 30-day readmissions between the outpatient and inpatient cohorts, it seems that outpatient PLF may be appropriately considered for select patients. However, extremely careful patient selection should be exercised.
越来越多的人对在门诊进行腰椎后路融合术（PLF）以提高患者满意度和降低成本感兴趣。尽管这种情况仅在一小部分病例中发生，但由于手术技术和麻醉的进步，这种情况变得更加可能。然而，在大样本量中，关于门诊与住院 PLF 围手术期过程的数据仍然很少。
本研究旨在比较美国外科医师学会国家手术质量改进计划（NSQIP）数据库中门诊和住院 PLF 患者的围手术期并发症。
研究设计/设置：进行了回顾性队列比较研究。
该样本来自 2005 年至 2015 年 NSQIP 数据库中接受 PLF 加或不加椎间融合的患者。
术后 30 天内的并发症和术后 30 天内的再入院。
在 2005-2015 年 NSQIP 数据库中确定接受 PLF 加或不加椎间融合的患者。门诊手术定义为住院时间（LOS）=0 天的病例，而住院手术定义为 LOS=1-30 天的病例。比较两组患者的人口统计学特征、合并症和手术变量（包括椎间融合、器械和融合节段数）。然后对两组之间的术后并发症和 30 天再入院进行倾向评分匹配比较。
本研究共纳入 360 例门诊和 36610 例住院 PLF 病例。在进行倾向评分匹配以控制潜在混杂因素后，统计分析显示，除门诊组输血率明显较低外（2.78% vs. 10.83%，p<.001），两组患者的术后不良事件无显著差异。值得注意的是，两组患者的再入院率无差异。
基于门诊组和住院组在大多数围手术期并发症和 30 天再入院率方面无差异，似乎可以适当考虑为部分患者选择门诊 PLF。但是，应非常谨慎地选择患者。
