30 天和 90 天非计划性再入院率、原因及颈椎融合术后的危险因素：单中心分析。
30- and 90-Day Unplanned Readmission Rates, Causes, and Risk Factors After Cervical Fusion: A Single-Institution Analysis.
机构信息
College of Medicine, The Ohio State University, Columbus, OH.
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
出版信息
Spine (Phila Pa 1976). 2019 Jun 1;44(11):762-769. doi: 10.1097/BRS.0000000000002937.
STUDY DESIGN
Retrospective cohort study OBJECTIVE.: To study 30- and 90-day readmission rates, causes, and risk factors after anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF).
SUMMARY OF BACKGROUND DATA
Existing data on readmission after cervical fusion is majorly derived from national databases. Given their inherent limitations in accuracy, follow-up available, and missing data, we intend to add to literature from our institutional analysis.
METHODS
Patients who underwent ACDF and PCF for degenerative cervical pathology in 2013 and 2014 were identified for the study. Comprehensive chart review was performed to record demographics and clinical patient profile. Hospital readmission within 30 and 90 days was identified, and the causes and management were recorded. Binary logistic regression analysis was done to study risk factors for readmission. ACDF and PCF were studied separately.
RESULTS
Our analysis included a total of 549 patients, stratified as 389 ACDFs and 160 PCFs. The 30- and 90-day unplanned readmission rate was 5.1% and 7.7% after ACDF. These rates were 11.2% and 16.9% after PCF. The most common cause of readmission was systemic infection and sepsis after ACDF and PCF (31.4% and 25.8% of readmitted, respectively), followed by pulmonary complications after ACDF (14.3% of readmitted) and wound complications after PCF (19.4% of readmitted). Predictors of readmission after ACDF included heart failure, history of malignancy, history of deep vein thrombosis/pulmonary embolism, and any intraoperative complication. In the PCF cohort, history of ischemic heart disease, increasing number of fusion levels and longer length of stay were independently predictive.
CONCLUSION
The rates, causes, and risk factors of readmission after ACDF and PCF have been identified. There is variation in published data regarding the incidence and risk factors for readmission after cervical fusion; however, majority of readmissions occur due to medical complications and systemic infection.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究
目的
研究颈椎前路椎间盘切除融合术（ACDF）和颈椎后路融合术（PCF）后 30 天和 90 天的再入院率、原因和危险因素。
背景资料概述
现有关于颈椎融合后再入院的数据主要来源于国家数据库。由于其在准确性、可获得的随访和数据缺失方面存在固有局限性，我们打算从我们的机构分析中增加文献。
方法
对 2013 年和 2014 年因退行性颈椎病变行 ACDF 和 PCF 的患者进行了研究。进行了全面的病历回顾，记录了人口统计学和临床患者特征。确定了 30 天和 90 天内的医院再入院情况，并记录了再入院的原因和处理方法。进行了二元逻辑回归分析，以研究再入院的危险因素。分别对 ACDF 和 PCF 进行了研究。
结果
我们的分析共纳入了 549 例患者，分为 389 例 ACDF 和 160 例 PCF。ACDF 后 30 天和 90 天的非计划性再入院率分别为 5.1%和 7.7%。PCF 后分别为 11.2%和 16.9%。再入院的最常见原因是 ACDF 和 PCF 术后全身感染和败血症（分别为再入院的 31.4%和 25.8%），其次是 ACDF 术后肺部并发症（再入院的 14.3%）和 PCF 术后伤口并发症（再入院的 19.4%）。ACDF 再入院的预测因素包括心力衰竭、恶性肿瘤史、深静脉血栓形成/肺栓塞史和任何术中并发症。在 PCF 队列中，缺血性心脏病史、融合节段数增加和住院时间延长是独立的预测因素。
结论
确定了 ACDF 和 PCF 后再入院的发生率、原因和危险因素。关于颈椎融合后再入院的发生率和危险因素的发表数据存在差异；然而，大多数再入院是由于医疗并发症和全身感染。
证据水平
3 级。
Zotero 插件