成人脊柱畸形初次手术后再入院率、住院时间和死亡率：丹麦一项为期 10 年的全国队列研究。
Readmissions, Length of Stay, and Mortality After Primary Surgery for Adult Spinal Deformity: A 10-Year Danish Nationwide Cohort Study.
机构信息
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
出版信息
Spine (Phila Pa 1976). 2019 Jan 15;44(2):E107-E116. doi: 10.1097/BRS.0000000000002782.
STUDY DESIGN
Cohort study.
OBJECTIVE
To report outcome after primary surgery for adult spinal deformity (ASD), and assess risk factors for extended length of stay (extLOS) and readmission within 90 days.
SUMMARY OF BACKGROUND DATA
Complications after ASD surgery have been reported in 20% to 50% of patients. A few studies have focused on detailed information concerning postoperative morbidity.
METHODS
Patients >18 years undergoing primary instrumented surgery for ASD in Denmark in the period 2006 to 2016 were included. Patients were identified in the Danish National Patient Registry (DNPR) using procedure codes for instrumented spine surgery combined with diagnosis of spinal deformity. Information on length of stay (LOS), readmissions, and mortality were retrieved from the DNPR. Medical records were reviewed for causes of extLOS (LOS >10 days) and readmission within 90 days after surgery. Charlson Comorbidity Index (CCI) was calculated for all patients based on DNPR.
RESULTS
We included 892 patients. Median LOS was 8 days (interquartile range, IQR, 7-11). A total of 175 (28.0%) patients had extLOS; 81% because of "medically" related complications. Most common medically related reason (>50%) for extLOS was pain/mobilization difficulties. The 90-days readmission risk was 13.8%; 74.5% of readmissions were "medically" related, primarily opioid related side effects (18.2%), and pain/mobilization issues (15.2%); 25.5% of readmissions were "surgically" related and 16.7% of patients required revision surgery. Ninety-days mortality was 0.9%. Age groups 61 to 70 years, >70 years, CCI score 1 to 2 and CCI score ≥3 were associated with increased risk of extLOS (odds ratio, OR = 1.79, 2.01, 1.81, and 2.49, respectively). Age group >70 years and CCI score 1 to 2 were associated with increased risk of readmission (OR = 2.21 and 1.83).
CONCLUSION
Increasing age and comorbidity were associated with increased risk extLOS and readmission. Pain/mobilization difficulties were the most common postoperative complications. A future focus on early mobilization and pain management may improve outcome of ASD patients.
LEVEL OF EVIDENCE
研究设计
队列研究。
目的
报告成人脊柱畸形（ASD）初次手术后的结果，并评估延长住院时间（extLOS）和 90 天内再入院的风险因素。
背景资料总结
已有 20%至 50%的 ASD 手术后患者出现并发症。少数研究集中于术后发病率的详细信息。
方法
纳入 2006 年至 2016 年期间在丹麦接受初次器械性脊柱畸形手术的＞18 岁患者。通过丹麦国家患者登记处（DNPR）中脊柱畸形诊断和手术器械的程序代码识别患者。从 DNPR 中检索住院时间（LOS）、再入院和死亡率的信息。对 extLOS（LOS＞10 天）和手术后 90 天内再入院的原因进行医学记录审查。根据 DNPR 为所有患者计算 Charlson 合并症指数（CCI）。
结果
共纳入 892 例患者。中位 LOS 为 8 天（四分位间距 IQR，7-11）。共有 175 例（28.0%）患者存在 extLOS；81%是由于“医学上”相关并发症导致的。最常见的医学相关原因（＞50%）是疼痛/活动困难。90 天的再入院风险为 13.8%；74.5%的再入院是“医学上”相关的，主要是阿片类药物相关的副作用（18.2%）和疼痛/活动问题（15.2%）；25.5%的再入院是“手术上”相关的，16.7%的患者需要再次手术。90 天死亡率为 0.9%。61 至 70 岁、＞70 岁、CCI 评分 1 至 2 和 CCI 评分≥3 与 extLOS 的风险增加相关（比值比 OR = 1.79、2.01、1.81 和 2.49）。＞70 岁和 CCI 评分 1 至 2 与再入院风险增加相关（OR = 2.21 和 1.83）。
结论
年龄增长和合并症与 extLOS 和再入院风险增加相关。疼痛/活动困难是最常见的术后并发症。未来关注早期活动和疼痛管理可能会改善 ASD 患者的结局。
证据水平
3。
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