Boylan Matthew R, Riesgo Aldo M, Chu Alice, Paulino Carl B, Feldman David S
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York.
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
J Pediatr Orthop B. 2019 Jan;28(1):27-31. doi: 10.1097/BPB.0000000000000543.
Accelerated discharge protocols for scoliosis surgery have recently been described in the literature. There are limited data describing the association of length of stay (LOS) during the index admission with postoperative outcomes. We sought to define the economic and clinical implications of an additional 1 day in the hospital for scoliosis surgery. The Statewide Planning and Research Cooperative System database was used to identify patients with adolescent idiopathic scoliosis who underwent spinal fusion from 1 October 2007 to 30 September 2012 at high-volume institutions (>20 cases/year) in the state of New York. Regression models were adjusted for age, sex, race, insurance, comorbidity score, and perioperative complications during the index admission. Among the 1286 patients with AIS who underwent spinal fusion, the mean LOS was 4.90 days [95% confidence interval (CI)=4.84-4.97; SD=1.19]. In the perioperative period, 605 (47.05%) underwent transfusion and 202 (15.71%) had problems with pain control. An additional 1 day in the hospital was associated with $11 033 (95% CI=7162-14 904; P<0.001) in insurance charges, $5198 (95% CI=4144-6252; P<0.001) in hospital costs, 28% increased risk (odds ratio=1.28; 95% CI=1.01-1.63; P=0.041) of all-cause 90-day readmission, and a 57% increased risk (odds ratio=1.57; 95% CI=1.13-2.17; P=0.007) of returning to the operating room within 90 days. Increased LOS during the index admission scoliosis surgery is associated with higher costs and an increased risk of 90-day postoperative complications. Protocols to decrease LOS for this surgery have potential benefits to patients, hospitals, and insurers. Level of Evidence: Level III, retrospective comparative study.
近期文献中已阐述了脊柱侧弯手术的加速出院方案。关于初次住院期间住院时长（LOS）与术后结局之间关联的数据有限。我们试图明确脊柱侧弯手术住院时间增加1天的经济和临床影响。利用全州规划与研究合作系统数据库，识别出2007年10月1日至2012年9月30日在纽约州高容量机构（每年>20例）接受脊柱融合术的青少年特发性脊柱侧弯患者。回归模型针对年龄、性别、种族、保险、合并症评分以及初次住院期间的围手术期并发症进行了调整。在1286例接受脊柱融合术的AIS患者中，平均住院时长为4.90天[95%置信区间（CI）=4.84-4.97；标准差=1.19]。围手术期，605例（47.05%）接受了输血，202例（15.71%）存在疼痛控制问题。住院时间增加1天与保险费用增加11033美元（95%CI=7162-14904；P<0.001）、医院成本增加5198美元（95%CI=4144-6252；P<0.001）、全因90天再入院风险增加28%（比值比=1.28；95%CI=1.01-1.63；P=0.041）以及90天内返回手术室的风险增加57%（比值比=1.57；95%CI=1.13-2.17；P=0.007）相关。初次住院期间脊柱侧弯手术住院时长增加与更高的成本以及90天术后并发症风险增加相关。减少该手术住院时长的方案对患者、医院和保险公司具有潜在益处。证据级别：III级，回顾性比较研究。
