Martin Christopher T, D'Oro Anthony, Buser Zorica, Youssef Jim A, Park Jong-Beom, Meisel Hans-Joerg, Brodke Darrel S, Wang Jeffrey C, Yoon S Tim
Christopher T. Martin, MD, Department of Orthopaedic Surgery, University of Minnesota Minneapolis, MN 55454 (Email:
The Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Iowa Orthop J. 2018;38:167-176.
Epidemiologic Study.
To identify the trends in utilization of outpatient discharge for single level anterior cervical discectomy and fusion (ACDF), between 2007 and 2014, and to compare the costs and incidence of complications against a cohort of inpatients.
We retrospectively reviewed 18,386 patients from the PearlDiver database from between 2007 and 2014. Discharge status was determined from billing codes. The total cost of all procedures and diagnostic tests, was determined for the global period from the time of diagnosis up until 90-days post-operatively, and the incidence of complications was recorded for 30-days.
The proportion of outpatient discharges was stable around 20% from 2007 to 2014 (range17-23%). The mean 90-day cost was lower for outpatients ($39,528 v. $47,330) but reimbursement fell nearly 1/3 from 2007-2014 for both groups, and the difference between the two narrowed over time ($13,745 difference in 2008, to $3,834 in 2014). Outpatients had a lower incidence of overall 30-day complications (9.5% v. 18.6%, p<0.0001), but were also significantly less comorbid (mean Charlson comorbidity index 2.32 v. 3.85, p<0.001). Older patient age, obesity, cardiac, renal, and pulmonary comorbidity were each more common in the inpatients (p<0.05 for each).
Outpatient discharge after ACDF is a viable treatment option with a reasonable safety profile and decreased costs relative to inpatient admission. Appropriate patient selection is key, and the standard of care nationally for the comorbid patient remains inpatient admission. The economic trends and epidemiologic data presented here should be useful for health policy decisions.
流行病学研究。
确定2007年至2014年间单节段颈椎前路椎间盘切除融合术（ACDF）门诊出院的使用趋势，并与一组住院患者比较并发症的成本和发生率。
我们回顾性分析了2007年至2014年间PearlDiver数据库中的18386例患者。出院状态根据计费代码确定。确定从诊断时起直至术后90天的全球期间内所有手术和诊断检查的总成本，并记录30天内的并发症发生率。
2007年至2014年，门诊出院比例稳定在20%左右（范围为17%-23%）。门诊患者的90天平均成本较低（39528美元对47330美元），但两组从2007年至2014年的报销费用均下降了近三分之一，且两者之间的差异随时间缩小（2008年相差13745美元，到2014年相差3834美元）。门诊患者30天总体并发症发生率较低（9.5%对18.6%，p<0.0001），但合并症也明显较少（平均Charlson合并症指数2.32对3.85，p<0.001）。老年患者、肥胖、心脏、肾脏和肺部合并症在住院患者中更为常见（每项p<0.05）。
ACDF术后门诊出院是一种可行的治疗选择，具有合理的安全性，且相对于住院入院成本降低。合适的患者选择是关键，对于合并症患者，全国的护理标准仍是住院入院。此处呈现的经济趋势和流行病学数据应有助于卫生政策决策。
