Adogwa Owoicho, Lilly Daniel T, Vuong Victoria D, Desai Shyam A, Ouyang Bichun, Khalid Syed, Khanna Ryan, Bagley Carlos A, Cheng Joseph
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
World Neurosurg. 2018 Jul;115:e552-e557. doi: 10.1016/j.wneu.2018.04.094. Epub 2018 Apr 22.
Health care systems are increasing efforts to minimize postoperative hospital stays to improve resource use. Common explanations for extended postoperative stay are baseline patient sickness, postoperative complications, or physician practice differences. However, the degree to which extended length of stay (LOS) represents patient illness or postoperative complications remains unknown. The aim is to investigate the influence of postoperative complications and elderly patient comorbidities on extended LOS after anterior cervical discectomy and fusion.
This retrospective study was performed from January 1, 2008, to December 31, 2014, on data from the American College of Surgeons National Surgical Quality Improvement Program. Patient demographics, comorbidities, LOS, and inpatient complications were recorded. Multivariable logistic regression analysis was used to determine the odds ratio for risk-adjusted extended LOS. The primary outcome was the degree extended LOS represented patient illness or postoperative complications.
Of 4730 participants, 1351 (28.56%) had extended LOS. A minority of patients with extended LOS had a history of relevant comorbidities-diabetes (29.53%), chronic obstructive pulmonary disease (9.4%), congestive heart failure (1.04%), myocardial infarction (0.33%), acute renal failure (0.3%), and stroke (5.92%). Among patients with normal LOS, 96.8% had no complications, 2.7% had 1 complication, and 0.5% had greater than 1 complication. In patients with extended LOS, 79.4% had no complications, 14.5% had 1 complication, and 6.1% had greater than 1 complication (P < 0.0001).
Our study suggests much of LOS variation after an anterior cervical discectomy and fusion is not attributable to baseline patient illness or complications and most likely represents differences in practice style or surgeon preference.
医疗保健系统正在加大努力，尽量缩短术后住院时间，以提高资源利用效率。术后住院时间延长的常见原因包括患者基线疾病、术后并发症或医生的医疗行为差异。然而，住院时间延长在多大程度上代表患者疾病或术后并发症仍不清楚。本研究旨在探讨术后并发症和老年患者合并症对颈椎前路椎间盘切除融合术后住院时间延长的影响。
本回顾性研究对2008年1月1日至2014年12月31日期间美国外科医师学会国家外科质量改进计划的数据进行分析。记录患者的人口统计学信息、合并症、住院时间和住院并发症。采用多变量逻辑回归分析确定风险调整后住院时间延长的比值比。主要结局是住院时间延长在多大程度上代表患者疾病或术后并发症。
4730名参与者中，1351人（28.56%）住院时间延长。住院时间延长的患者中，少数有相关合并症病史，包括糖尿病（29.53%）、慢性阻塞性肺疾病（9.4%）、充血性心力衰竭（1.04%）、心肌梗死（0.33%）、急性肾衰竭（0.3%）和中风（5.92%）。住院时间正常的患者中，96.8%无并发症，2.7%有1种并发症，0.5%有1种以上并发症。住院时间延长的患者中，79.4%无并发症，14.5%有1种并发症，6.1%有1种以上并发症（P<0.0001）。
我们的研究表明，颈椎前路椎间盘切除融合术后住院时间的差异很大一部分并非归因于患者基线疾病或并发症，很可能代表了医疗行为方式或外科医生偏好的差异。
