Adogwa Owoicho, Desai Shyam A, Vuong Victoria D, Lilly Daniel T, Ouyang Bichun, Davison Mark, Khalid Syed, 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 Aug;116:e996-e1001. doi: 10.1016/j.wneu.2018.05.148. Epub 2018 Jun 1.
Hospital leaders are seeking ways to improve resource utilization and minimize long postoperative hospital stays. Common explanations for extended length of stay (LOS) are baseline patient illness, postoperative complications, and physician practice differences. The degree to which extended LOS represents illness severity or postoperative complications is unknown. We investigated influence of postoperative complications and patient comorbidities on extended LOS after lumbar spine surgery in elderly patients.
This retrospective cohort study from 2008 to 2014 analyzed data from the American College of Surgeons National Surgical Quality Improvement Program for elderly patients undergoing lumbar spine surgery. Patient demographics, comorbidities, LOS, and complications were recorded. Multivariable logistic regression analysis was used to determine odds ratio for risk-adjusted LOS. Primary outcome was the degree extended LOS represented patient illness or postoperative complications.
Of 9482 patients, 1909 (20.13%) had extended LOS. A few patients with extended LOS had a history of relevant comorbidities, including diabetes (21.76%), chronic obstructive pulmonary disease (8.17%), congestive heart failure (0.94%), myocardial infarction (0%), acute renal failure (0.47%), and stroke (2.23%). Of patients with normal LOS, 93% had no complications, 5.19% had 1 complication, and 1.69% had >1 complication. Among patients with extended LOS, 73.65% had no complications, 18.96% had 1 complication, and 7.39% had >1 complication (P < 0.000).
Our study suggests that much of the variation in LOS for elderly patients undergoing lumbar spine surgery is not attributable to baseline patient illness or postoperative complications and most likely represents differences in practice style or surgeon preference.
医院管理者正在寻求改善资源利用并尽量缩短术后住院时间的方法。住院时间延长（LOS）的常见原因包括患者基础疾病、术后并发症以及医生的医疗行为差异。住院时间延长在多大程度上代表疾病严重程度或术后并发症尚不清楚。我们调查了术后并发症和患者合并症对老年患者腰椎手术后住院时间延长的影响。
这项回顾性队列研究分析了2008年至2014年美国外科医师学会国家外科质量改进计划中接受腰椎手术的老年患者的数据。记录了患者的人口统计学特征、合并症、住院时间和并发症。采用多变量逻辑回归分析来确定风险调整后住院时间的比值比。主要结果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。
9482例患者中，1909例（20.13%）住院时间延长。少数住院时间延长的患者有相关合并症病史，包括糖尿病（21.76%）、慢性阻塞性肺疾病（8.17%）、充血性心力衰竭（0.94%）、心肌梗死（0%）、急性肾衰竭（0.47%）和中风（2.23%）。住院时间正常的患者中，93%无并发症，5.19%有1种并发症，1.69%有1种以上并发症。住院时间延长的患者中，73.65%无并发症，18.96%有1种并发症，7.39%有1种以上并发症（P<0.000）。
我们的研究表明，老年腰椎手术患者住院时间的差异很大程度上并非归因于患者基础疾病或术后并发症，很可能代表了医疗行为方式或外科医生偏好的差异。
