Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Spine (Phila Pa 1976). 2019 Jan 15;44(2):118-122. doi: 10.1097/BRS.0000000000002758.
Retrospective study of a national database.
To identify the incidence and risk factors for discharge to a rehabilitation facility after corrective surgery for adolescent idiopathic scoliosis (AIS).
The vast majority of patients who undergo surgery for AIS are discharged home, with limited data on rates and causes for discharge to a rehabilitation facility.
The United States National Inpatient Sample (NIS) database was queried for the years 2012 to 2014. Inclusion criteria were children aged 10 to 18 who underwent surgery for idiopathic scoliosis. Studied data included patient demographics, operative parameters, length of stay, and hospital charges. Perioperative complications were also examined, along with their association with discharge to an inpatient rehabilitation facility. Statistical analysis was performed via chi-squared testing and multivariate analysis, with significance defined as a P-value <0.05.
A total of 17,275 patients were included (76.3% female, mean age 14 yr). Out of the entire cohort, 4.8% of patients developed a complication and 0.6% were discharged to a rehabilitation facility. The most common complications included respiratory failure (2.3%), reintubation (0.8%), and postoperative hematoma (0.8%). Following multivariate analysis, male sex (Odds ratio (OR) 4.7; 95% Confidence Interval (CI), 1.8-12.2; P = 0.002), revision surgery (OR 29.6; 95% CI, 5.7-153.5; P < 0.001), and development of a perioperative complication (OR 12.3; 95% CI, 4.7-32.4; P < 0.001) were found to be significant predictors of discharge to rehabilitation. Average length of stay was 8 ± 6 versus 5 ± 3 days and hospital charges were $254,425 versus $186,273 in the complication and control groups, respectively (both P < 0.001).
Discharge to rehabilitation after AIS surgery is uncommon. However, patients who are male, undergo revision procedures, or develop a complication may have a higher risk of a non-routine discharge. Complication occurrence also resulted in significantly longer lengths of stay and healthcare costs.
全国数据库的回顾性研究。
确定青少年特发性脊柱侧凸（AIS）矫正手术后患者入住康复机构的发生率和风险因素。
绝大多数接受 AIS 手术的患者都出院回家，关于入住康复机构的比例和原因的数据有限。
对 2012 年至 2014 年期间的美国国家住院患者样本（NIS）数据库进行了查询。纳入标准为年龄在 10 至 18 岁之间接受特发性脊柱侧凸手术的儿童。研究数据包括患者人口统计学资料、手术参数、住院时间和住院费用。还检查了围手术期并发症及其与入住住院康复机构的关系。通过卡方检验和多变量分析进行统计学分析，显著性定义为 P 值<0.05。
共纳入 17275 例患者（76.3%为女性，平均年龄 14 岁）。在整个队列中，4.8%的患者发生并发症，0.6%的患者出院到康复机构。最常见的并发症包括呼吸衰竭（2.3%）、再次插管（0.8%）和术后血肿（0.8%）。多变量分析后发现，男性（优势比[OR]4.7；95%置信区间[CI]，1.8-12.2；P=0.002）、翻修手术（OR 29.6；95%CI，5.7-153.5；P<0.001）和围手术期并发症的发生（OR 12.3；95%CI，4.7-32.4；P<0.001）是出院到康复的显著预测因素。并发症组和对照组的平均住院时间分别为 8±6 天和 5±3 天，住院费用分别为 254425 美元和 186273 美元（均 P<0.001）。
AIS 手术后入住康复机构的情况并不常见。然而，男性、接受翻修手术或发生并发症的患者可能有更高的非常规出院风险。并发症的发生也导致了住院时间和医疗费用的显著增加。
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