Di Capua John, Somani Sulaiman, Lugo-Fagundo Nahyr, Kim Jun S, Phan Kevin, Lee Nathan J, Kothari Parth, Shin John, Cho Samuel K
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ponce Health Sciences University, Ponce, PR, USA.
Global Spine J. 2018 May;8(3):266-272. doi: 10.1177/2192568217717971. Epub 2017 Jul 20.
Retrospective cohort study.
Adult spinal deformity (ASD) surgery encompasses a wide variety of spinal disorders and is associated with a morbidity rate between 20% and 80%. The utilization of spinal surgery has increased and this trend is expected to continue. To effectively deal with an increasing patient volume, identifying variables associated with patient discharge destination can expedite placement and reduce length of stay.
The 2013-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision diagnosis codes relevant to ASD. Patients were divided based on discharge destination. Bivariate and multivariate logistic regression analyses were employed to identify predictors for patient discharge destination and hospital length of stay.
A total of 4552 patients met inclusion criteria, of which 1102 (24.2%) had non-home discharge. Multivariate regression revealed total relative value unit (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.00-1.01); female sex (OR = 1.54, 95% CI = 1.32-1.81); American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander versus black race (OR = 0.52, 95% CI = 0.35-0.78, = .002); age ≥65 years (OR = 3.72, 95% CI = 3.19-4.35); obesity (OR = 1.18, 95% CI = 1.01-1.38, = .034); partially/totally functionally dependent (OR = 2.11, 95% CI = 1.49-2.99); osteotomy (OR = 1.42, 95% CI = 1.12-1.80, = .004) pelvis fixation (OR = 2.38, 95% CI = 1.82-3.11); operation time ≥4 hours (OR = 1.74, 95% CI = 1.47-2.05); recent weight loss (OR = 7.66, 95% CI = 1.52-38.65; = .014); and American Society of Anesthesiologists class ≥3 (OR = 1.80, 95% CI = 1.53-2.11) as predictors of non-home discharge. values were <.001 unless otherwise noted. Additionally, multivariate regression found non-home discharge to be a significant variable in prolonged length of stay.
The authors suggest these results can be used to inform patients preoperatively of expected discharge destination, anticipate patient discharge needs postoperatively, and reduce health care costs and morbidity associated with prolonged LOS.
回顾性队列研究。
成人脊柱畸形（ASD）手术涵盖多种脊柱疾病，发病率在20%至80%之间。脊柱手术的使用率有所增加，且这一趋势预计将持续。为有效应对不断增加的患者数量，识别与患者出院目的地相关的变量可加快安置并缩短住院时间。
使用与ASD相关的当前手术操作术语和国际疾病分类第九版诊断编码查询2013 - 2014年美国外科医师学会国家外科质量改进计划数据库。患者根据出院目的地进行分组。采用双变量和多变量逻辑回归分析来确定患者出院目的地和住院时间的预测因素。
共有4552例患者符合纳入标准，其中1102例（24.2%）未回家出院。多变量回归显示总相对价值单位（比值比[OR]=1.01，95%置信区间[CI]=1.00 - 1.01）；女性（OR = 1.54，95% CI = 1.32 - 1.81）；美洲印第安人、阿拉斯加原住民、亚洲人、夏威夷原住民或太平洋岛民与黑人种族相比（OR = 0.52，95% CI = 0.35 - 0.78，P =.002）；年龄≥65岁（OR = 3.72，95% CI = 3.19 - 4.35）；肥胖（OR = 1.18，95% CI = 1.01 - 1.38，P =.034）；部分/完全功能依赖（OR = 2.11，95% CI = 1.49 - 2.99）；截骨术（OR = 1.42，95% CI = 1.12 - 1.80，P =.004）骨盆固定（OR = 2.38，95% CI = 1.82 - 3.11）；手术时间≥4小时（OR = 1.74，95% CI = 1.47 - 2.05）；近期体重减轻（OR = 7.66，95% CI = 1.52 - 38.65；P =.014）；以及美国麻醉医师协会分级≥3（OR = 1.80，95% CI = 1.53 - 2.11）是非回家出院的预测因素。除非另有说明，P值均<.001。此外，多变量回归发现非回家出院是住院时间延长的一个重要变量。
作者认为这些结果可用于在术前告知患者预期的出院目的地，预测术后患者的出院需求，并降低与住院时间延长相关的医疗保健成本和发病率。
