腰椎后路融合术后出院目的地作为术后结果和再入院的预测因素
Discharge Destination as a Predictor of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion.
作者信息
Arrighi-Allisan Annie E, Neifert Sean N, Gal Jonathan S, Deutsch Brian C, Caridi John M
机构信息
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
出版信息
World Neurosurg. 2019 Feb;122:e139-e146. doi: 10.1016/j.wneu.2018.09.147. Epub 2018 Sep 27.
BACKGROUND
Posterior lumbar fusions are performed to treat various spinal deformities, degenerative diseases, fractures, infections, and tumors. The possibility of episode-based bundled payments for spine surgery necessitates analysis of the factors predicting readmissions and postoperative complications.
METHODS
Patients undergoing posterior lumbar fusion in the American College of Surgeons National Surgical Quality Improvement Program were queried via Current Procedural Terminology codes 22630, 22633, and 22612. Patients were grouped based on discharge destination, either to home/home health care or to a facility. Relevant demographics, comorbidities, perioperative statistics, and predischarge and postdischarge complications were compared. Multivariable logistic regression models for severe postdischarge complications and 30-day readmissions were created with the exposure of nonhome discharge.
RESULTS
Patients discharged to nonhome destinations were significantly older (68.42 vs. 58.15 years; P < 0.0001), sicker (68.11% of patients had American Society of Anesthesiologists Physical Status Classification > 2 vs. 44.25%; P < 0.0001), more dependent (5.92% vs. 1.40%; P < 0.0001), and had significantly greater body mass indices (10.60% of patients had body mass index > 40 vs. 7.63%; P < 0.0001) than patients discharged home. Following discharge, patients in the nonhome discharge group experienced higher mortality (0.28% vs. 0.08%; P < 0.0001) and were more likely to experience a severe complication (5.96% vs. 2.85%; P < 0.0001), minor complication (4.59% vs. 1.74%; P < 0.0001), and readmission (8.92% vs. 4.78%; P < 0.0001). Nonhome discharge proved to be a risk factor for both readmission (odds ratio 1.43; 95% confidence interval 1.28-1.60; P < 0.0001) and severe postdischarge complication (odds ratio 1.73; 95% confidence interval 1.52-1.97; P < 0.0001).
CONCLUSIONS
Nonhome discharge patients experienced higher rates of complications and 30-day readmissions.
背景
腰椎后路融合术用于治疗各种脊柱畸形、退行性疾病、骨折、感染和肿瘤。脊柱手术按病例计费的可能性使得有必要分析预测再入院和术后并发症的因素。
方法
通过现行手术操作术语编码22630、22633和22612查询美国外科医师学会国家外科质量改进计划中接受腰椎后路融合术的患者。根据出院目的地将患者分组，即回家/接受家庭医疗护理或前往医疗机构。比较相关的人口统计学、合并症、围手术期统计数据以及出院前和出院后的并发症。以非家庭出院为暴露因素，建立严重出院后并发症和30天再入院的多变量逻辑回归模型。
结果
出院前往非家庭目的地的患者明显年龄更大（68.42岁对58.15岁；P<0.0001），病情更严重（68.11%的患者美国麻醉医师协会身体状况分类>2对44.25%；P<0.0001），依赖性更强（5.92%对1.40%；P<0.0001），且体重指数明显更高（10.60%的患者体重指数>40对7.63%；P<0.0001）。出院后，非家庭出院组患者的死亡率更高（0.28%对0.08%；P<0.0001），更有可能发生严重并发症（5.96%对2.85%；P<0.0001）、轻微并发症（4.59%对1.74%；P<0.0001）和再入院（8.92%对4.78%；P<0.0001）。非家庭出院被证明是再入院（比值比1.43；95%置信区间1.28 - 1.60；P<0.0001）和严重出院后并发症（比值比1.73；95%置信区间1.52 - 1.97；P<0.0001）的危险因素。
结论
非家庭出院患者的并发症发生率和30天再入院率更高。
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