Ye Ivan, Phan Kevin, Cheung Zoe B, White Samuel J W, Nguyen Jacqueline, Cho Brian, Kim Jun S, Cho Samuel K
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, New South Wales, Australia.
World Neurosurg. 2018 Nov;119:e574-e579. doi: 10.1016/j.wneu.2018.07.213. Epub 2018 Aug 2.
To identify risk factors that are predictive of nonhome discharge after elective posterior cervical fusion.
We performed a retrospective cohort study of adult patients who underwent elective posterior cervical fusion using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2014. Patients were divided into 2 groups: home discharge and nonhome discharge. Univariate analysis was performed to compare incidence of 30-day postoperative complications between groups. Multivariate analysis was performed to identify complications that were predictive of nonhome discharge.
The cohort included 2875 patients; 24.1% were discharged to a nonhome facility, including skilled and nonskilled care facilities, nursing homes, assisted living facilities, and rehabilitation facilities. Nonhome discharge was associated with higher rates of 30-day pulmonary complication, cardiac complication, venous thromboembolism, urinary tract infection, blood transfusion, sepsis, and reoperation. Significant predictors of nonhome discharge were wound complication (odds ratio [OR] = 1.73; 95% confidence interval [CI], 1.07-2.80; P = 0.024), pulmonary complication (OR = 3.61; 95% CI, 1.96-6.63; P < 0.001), cardiac complication (OR = 6.13; 95% CI, 1.61-23.4; P = 0.008), venous thromboembolism (OR = 2.97; 95% CI, 1.43-6.19; P = 0.004), urinary tract infection (OR = 2.69; 95% CI, 1.50-4.82; P < 0.001), blood transfusion (OR = 1.70; 95% CI, 1.20-2.39; P = 0.003), sepsis (OR = 2.75; 95% CI, 1.25-6.02; P = 0.012), and prolonged length of stay (OR = 4.07; 95% CI, 3.34-4.95; P < 0.001).
Early identification of patients who are at high risk for nonhome discharge is important to implement early comprehensive discharge planning protocols and minimize hospital-acquired conditions related to prolonged length of stay and associated health care costs.
确定择期颈椎后路融合术后非回家出院的预测风险因素。
我们利用美国外科医师学会国家外科质量改进计划数据库，对2010年至2014年接受择期颈椎后路融合术的成年患者进行了一项回顾性队列研究。患者分为两组：回家出院组和非回家出院组。进行单因素分析以比较两组术后30天并发症的发生率。进行多因素分析以确定可预测非回家出院的并发症。
该队列包括2875例患者；24.1%的患者出院至非家庭机构，包括专业和非专业护理机构、疗养院、辅助生活设施和康复机构。非回家出院与30天肺部并发症、心脏并发症、静脉血栓栓塞、尿路感染、输血、败血症和再次手术的发生率较高相关。非回家出院的显著预测因素包括伤口并发症（比值比[OR]=1.73；95%置信区间[CI]，1.07 - 2.80；P = 0.024）、肺部并发症（OR = 3.61；95% CI，1.96 - 6.63；P < 0.001）、心脏并发症（OR = 6.13；95% CI，1.61 - 23.4；P = 0.008）、静脉血栓栓塞（OR = 2.97；95% CI，1.43 - 6.19；P = 0.004）、尿路感染（OR = 2.69；95% CI，1.50 - 4.82；P < 0.001）、输血（OR = 1.70；95% CI，1.20 - 2.39；P = 0.003）、败血症（OR = 2.75；95% CI，1.25 - 6.02；P = 0.012）和住院时间延长（OR = 4.07；95% CI，3.34 - 4.95；P < 0.001）。
早期识别有非回家出院高风险的患者对于实施早期综合出院计划方案以及尽量减少与住院时间延长相关的医院获得性疾病和相关医疗保健成本非常重要。
