Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan.
Neurosurgery. 2019 Sep 1;85(3):402-408. doi: 10.1093/neuros/nyy358.
Most studies have evaluated 30-d readmissions after lumbar fusion surgery. Evaluation of the 90-d period, however, allows a more comprehensive assessment of factors associated with readmission.
To assess the reasons and risk factors for 90-d readmissions after lumbar fusion surgery.
The Michigan Spine Surgery Improvement Collaborative (MSSIC) registry is a prospective, multicenter, and spine-specific database of patients surgically treated for degenerative disease. MSSIC data were retrospectively analyzed for causes of readmission, and independent risk factors impacting readmission were found by multivariate logistic regression.
Of 10 204 patients who underwent lumbar fusion, 915 (9.0%) were readmitted within 90 d, most commonly for pain (17%), surgical site infection (16%), and radicular symptoms (10%). Risk factors associated with increased likelihood of readmission were other race (odds ratio [OR] 1.81, confidence interval [CI] 1.22-2.69), coronary artery disease (OR 1.57, CI 1.25-1.96), ≥4 fused levels (OR 1.41, CI 1.06-1.88), diabetes (OR 1.34, CI 1.10-1.63), and surgery length (OR 1.09, CI 1.03-1.16). Factors associated with decreased risk were discharge to home (OR 0.63, CI 0.51-0.78), private insurance (OR 0.79, CI 0.65-0.97), ambulation same day of surgery (OR 0.81, CI 0.67-0.97), and spondylolisthesis diagnosis (OR 0.82, CI 0.68-0.97). Of those readmitted, 385 (42.1%) patients underwent another surgery.
Ninety-day readmission occurred in 9.0% of patients, mainly for pain, wound infection, and radicular symptoms. Increased focus on postoperative pain may decrease readmissions. Among factors impacting the likelihood of 90-d readmission, early postoperative ambulation may be most easily modifiable. Optimization of preexisting medical conditions could also potentially decrease readmission risk.
大多数研究评估了腰椎融合手术后 30 天的再入院情况。然而，评估 90 天期间可以更全面地评估与再入院相关的因素。
评估腰椎融合手术后 90 天再入院的原因和危险因素。
密歇根脊柱手术改进协作组（MSSIC）登记处是一个前瞻性、多中心、脊柱特异性数据库，包含接受退行性疾病手术治疗的患者。通过多变量逻辑回归分析 MSSIC 数据，以确定再入院的原因和影响再入院的独立危险因素。
在 10204 例接受腰椎融合术的患者中，90 天内有 915 例（9.0%）再入院，最常见的原因是疼痛（17%）、手术部位感染（16%）和神经根症状（10%）。与再入院可能性增加相关的危险因素包括其他种族（比值比[OR]1.81，95%置信区间[CI]1.22-2.69）、冠状动脉疾病（OR 1.57，CI 1.25-1.96）、融合≥4 个节段（OR 1.41，CI 1.06-1.88）、糖尿病（OR 1.34，CI 1.10-1.63）和手术时间（OR 1.09，CI 1.03-1.16）。与再入院风险降低相关的因素包括出院回家（OR 0.63，CI 0.51-0.78）、私人保险（OR 0.79，CI 0.65-0.97）、手术当天下地活动（OR 0.81，CI 0.67-0.97）和脊椎滑脱诊断（OR 0.82，CI 0.68-0.97）。在再入院的患者中，385 例（42.1%）再次接受手术。
90 天再入院率为 9.0%，主要原因为疼痛、伤口感染和神经根症状。术后更关注疼痛可能会降低再入院率。在影响 90 天再入院可能性的因素中，术后早期下地活动可能是最容易改变的因素。优化现有医疗条件也可能潜在降低再入院风险。
