Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA.
Spine (Phila Pa 1976). 2018 Nov 15;43(22):1559-1565. doi: 10.1097/BRS.0000000000002664.
A retrospective case-control study.
The aim of this study was to determine the nationwide trends and complication rates associated with outpatient posterior lumbar fusion (PLF).
Outpatient lumbar spine fusion is now possible secondary to minimally invasive techniques that allow for reduced hospital stays and analgesic requirements. Limited data are currently available regarding the clinical outcome of outpatient lumbar fusion.
The Humana administrative claims database was queried for patients who underwent one to two-level PLF (CPT-22612 or CPT-22633 AND ICD-9-816.2) as either outpatients or inpatients from Q1 2007 to Q2 2015. The incidence of perioperative medical and surgical complications was determined by querying for relevant International Classification of Diseases and Current Procedural Terminology codes. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index was used to calculate odds ratios (ORs) of complications among outpatients relative to inpatients undergoing PLF.
Cohorts of 770 patients who underwent outpatient PLF and 26,826 patients who underwent inpatient PLF were identified. The median age was in the 65 to 69 years age group for both cohorts. The annual relative incidence of outpatient PLF remained stable across the study period (R = 0.03, P = 0.646). Adjusting for age, gender, and comorbidities, patients undergoing outpatient PLF had higher likelihood of revision/extension of posterior fusion [(OR 2.33, confidence interval (CI) 2.06-2.63, P < 0.001], anterior fusion (OR 1.64, CI 1.31-2.04, P < 0.001), and decompressive laminectomy (OR 2.01, CI 1.74-2.33, P < 0.001) within 1 year. Risk-adjusted rates of all other postoperative surgical and medical complications were statistically comparable.
Outpatient lumbar fusion is uncommonly performed in the United States. Data collected from a national private insurance database demonstrate a greater risk of postoperative surgical complications including revision anterior and posterior fusion and decompressive laminectomy. Surgeons should be cautious in performing PLF in the outpatient setting, as the risk of revision surgery may increase in these cases.
回顾性病例对照研究。
本研究旨在确定与门诊后路腰椎融合术（PLF）相关的全国趋势和并发症发生率。
由于微创技术的发展，现在可以进行门诊腰椎融合术，从而减少住院时间和镇痛需求。目前关于门诊腰椎融合术的临床结果的数据有限。
从 2007 年第一季度到 2015 年第二季度，利用 Humana 行政索赔数据库，对接受 1 至 2 个节段 PLF（CPT-22612 或 CPT-22633 和 ICD-9-816.2）的患者进行了调查，这些患者要么是门诊患者，要么是住院患者。通过查询相关的国际疾病分类和当前程序术语代码，确定围手术期医疗和手术并发症的发生率。使用多变量逻辑回归调整年龄、性别和 Charlson 合并症指数，计算门诊患者与住院患者行 PLF 时并发症的优势比（OR）。
确定了 770 例门诊 PLF 患者和 26826 例住院 PLF 患者的队列。两个队列的中位年龄均在 65 至 69 岁之间。研究期间，门诊 PLF 的年相对发生率保持稳定（R=0.03，P=0.646）。调整年龄、性别和合并症后，行门诊 PLF 的患者在 1 年内有更高的可能性进行翻修/延长后路融合术（OR 2.33，95%置信区间[CI]2.06-2.63，P<0.001）、前路融合术（OR 1.64，CI 1.31-2.04，P<0.001）和减压性椎板切除术（OR 2.01，CI 1.74-2.33，P<0.001）。所有其他术后手术和医疗并发症的风险调整后发生率在统计学上均无差异。
在美国，门诊腰椎融合术并不常见。从全国私人保险数据库中收集的数据表明，术后手术并发症的风险更高，包括翻修前路和后路融合以及减压性椎板切除术。外科医生在门诊环境下进行 PLF 时应谨慎，因为在这些情况下，再次手术的风险可能会增加。
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