Department of Neurological Surgery, University of California, San Francisco, CA, USA.
Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
J Neurosurg Sci. 2021 Feb;65(1):54-62. doi: 10.23736/S0390-5616.18.04552-6. Epub 2018 Sep 25.
Spinal arteriovenous malformations (AVMs) are rare disease entities with significant morbidity if untreated. Risk factors of complications, hospitalization and costs-of-care remain in need of characterization.
Using the National Inpatient Sample years 2002-2014, adult subjects with spinal AVMs who underwent either laminectomy with lesion excision or endovascular embolization were extracted using ICD-9-CM diagnostic code 747.82. Predictors of inpatient complications, hospital length of stay (HLOS), and discharge home were evaluated using multivariable regression. Cost was evaluated using inflation-adjusted healthcare cost [charge*(cost/charge ratio)]. Mean differences (B), odds ratios (OR) and 95% CIs are reported. Significance was assessed at P<0.001.
In 2546 weighted admissions, age was 54.4±16.5-years (laminectomy: 70.0%, embolization: 30.0%). Fifteen percent suffered inpatient complications. Cost of hospitalization was $ 41216±38511 and was elevated for subjects with complications ($67571±2636, vs. no complications: $36562±723, P<0.001). Increased costs for categories of complications ranged from $ 16525 (renal/urinary) to $62246 (thromboembolism). In surgical subjects, complications were more costly ($ 69761±2896, vs. no complications: 36520±809, P<0.001). On multivariable analysis, major/extreme disease severity and major/extreme mortality risk were associated with increased complications and HLOS (P<0.001). Elective admissions had shorter HLOS (B=-4.3-days, [-4.8, -3.8], P<0.001) and higher odds of discharge home (OR=2.6 [2.1-3.2], P<0.001). Laminectomy (vs. embolization) was associated with complications (OR=2.6, 95% CI [1.7-3.8], P<0.001), HLOS (B=3.4-days [2.9-4.0], P<0.001), and decreased discharge home (OR=0.3 [0.2-0.4], P<0.001).
In spinal AVMs, high disease severity, non-elective admissions, and surgery are associated with complications, HLOS, and discharge to a non-home facility. Costs are elevated in patients suffering complications. Future studies are warranted.
脊髓动静脉畸形（AVM）是一种罕见的疾病实体，如果不治疗，会导致严重的发病率。目前仍需要对并发症、住院和治疗费用的风险因素进行特征描述。
利用 2002 年至 2014 年的国家住院患者样本，使用 ICD-9-CM 诊断代码 747.82，提取出接受椎板切除术联合病变切除术或血管内栓塞术治疗的脊髓 AVM 成年患者。使用多变量回归评估住院并发症、住院时间（HLOS）和出院回家的预测因素。使用经过通胀调整的医疗保健费用[收费×（费用/收费比）]评估费用。报告平均值差异（B）、比值比（OR）和 95%置信区间（CI）。P<0.001 时为差异有统计学意义。
在 2546 例加权入院患者中，年龄为 54.4±16.5 岁（椎板切除术：70.0%，栓塞术：30.0%）。15%的患者发生住院并发症。住院费用为 41216±38511 美元，并发症患者的费用更高（67571±2636 美元，无并发症患者：36562±723 美元，P<0.001）。各并发症类别的费用增加幅度从 16525 美元（肾脏/泌尿系统）到 62246 美元（血栓栓塞）不等。手术患者的并发症费用更高（69761±2896 美元，无并发症患者：36520±809 美元，P<0.001）。多变量分析显示，主要/极度疾病严重程度和主要/极度死亡风险与并发症和 HLOS 增加有关（P<0.001）。择期入院的 HLOS 更短（B=-4.3 天[-4.8，-3.8]，P<0.001），出院回家的几率更高（OR=2.6 [2.1-3.2]，P<0.001）。椎板切除术（与栓塞术相比）与并发症（OR=2.6，95%CI [1.7-3.8]，P<0.001）、HLOS（B=3.4 天[2.9-4.0]，P<0.001）和出院回家的几率降低（OR=0.3 [0.2-0.4]，P<0.001）有关。
在脊髓 AVM 中，疾病严重程度高、非择期入院和手术与并发症、HLOS 和出院至非家庭场所有关。并发症患者的费用更高。需要进一步研究。
