门诊和住院单节段颈椎全椎间盘置换：30 天结果比较。
Outpatient and Inpatient Single-level Cervical Total Disc Replacement: A Comparison of 30-day Outcomes.
机构信息
Emory University, Department of Orthopedic Surgery, Atlanta, GA.
出版信息
Spine (Phila Pa 1976). 2019 Jan 1;44(1):79-83. doi: 10.1097/BRS.0000000000002739.
STUDY DESIGN
A retrospective cohort study.
OBJECTIVE
The aim of this study was to compare 30-day postoperative outcomes between patients undergoing outpatient and inpatient single-level cervical total disc replacement (TDR) surgery.
SUMMARY OF BACKGROUND DATA
Cervical TDR is a motion-sparing treatment for cervical radiculopathy and myelopathy. It is an alternative to anterior cervical discectomy and fusion (ACDF) with a similar complication rate. Like ACDF, it may be performed in the inpatient or outpatient setting. Efforts to reduce health care costs are driving spine surgery to be performed in the outpatient setting. As cervical TDR surgery continues to gain popularity, the safety of treating patients on an outpatient basis needs to be validated.
METHODS
The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent single-level cervical disc replacement surgery between 2006 and 2015. Complication data including 30-day complications, reoperation rate, readmission rate, and length of stay data were compared between the inpatient and outpatient cohort using univariate analysis.
RESULTS
There were 531 (34.2%) patients treated as outpatients and 1022 (65.8%) were treated on an inpatient basis. The two groups had similar baseline characteristics. The overall 30-day complication rate was 1.4% for inpatients and 0.6% for outpatients. Reoperation rate was 0.6% for inpatient and 0.4% for outpatients. Readmission rate was 0.9% and 0.8% for inpatient and outpatient, respectively. There were no statistical differences identified in rates of readmission, reoperation, or complication between the inpatient and outpatient cohorts.
CONCLUSION
There was no difference between 30-day complications, readmission, and reoperation rates between inpatients and outpatients who underwent a single-level cervical TDR. Furthermore, the overall 30-day complication rates were low. This study supports that single-level cervical TDR can be performed safely in an outpatient setting.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
本研究旨在比较门诊和住院单节段颈椎间盘置换术（TDR）患者的 30 天术后结果。
背景资料概要
颈椎 TDR 是治疗颈椎神经根病和颈椎病的一种保留运动功能的治疗方法。它是前路颈椎间盘切除融合术（ACDF）的一种替代方法，具有相似的并发症发生率。与 ACDF 一样，它可以在住院或门诊环境下进行。为降低医疗保健成本，脊柱手术正逐渐在门诊环境下进行。随着颈椎 TDR 手术的普及，有必要验证在门诊基础上治疗患者的安全性。
方法
国家手术质量改进计划（NSQIP）数据库查询了 2006 年至 2015 年间接受单节段颈椎间盘置换术的患者。使用单变量分析比较了住院和门诊队列之间的 30 天并发症、再次手术率、再入院率和住院时间数据。
结果
有 531 例（34.2%）患者作为门诊患者接受治疗，1022 例（65.8%）患者作为住院患者接受治疗。两组患者的基线特征相似。总体 30 天并发症发生率为住院患者 1.4%，门诊患者 0.6%。再次手术率为住院患者 0.6%，门诊患者 0.4%。再入院率分别为住院患者 0.9%和门诊患者 0.8%。住院和门诊患者的再入院、再次手术或并发症发生率无统计学差异。
结论
在接受单节段颈椎 TDR 的住院和门诊患者中，30 天并发症、再入院和再次手术率无差异。此外，总体 30 天并发症发生率较低。本研究支持单节段颈椎 TDR 可在门诊安全进行。
证据等级
3 级
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