Malik Azeem Tariq, Yu Elizabeth, Kim Jeffery, Khan Safdar N
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
World Neurosurg. 2019 Mar;123:e482-e487. doi: 10.1016/j.wneu.2018.11.191. Epub 2018 Nov 27.
Recent literature has denoted care in an inpatient facility after discharge to be linked with worse outcomes after elective primary lumbar and cervical fusions. No study has explored the risk factors and associated postdischarge outcomes after discharge to inpatient facility after revision posterior lumbar fusion.
The 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program were queried using Current Procedural Terminology codes for posterior lumbar fusions (22630, 22633, 22614) combined with Current Procedural Terminology codes for revision-22830 (exploration of spinal fusion), 22849 (reinsertion of spinal fixation device), 22850 (removal of posterior nonsegmental instrumentation), and 22852 (removal of posterior segmental instrumentation).
Of 1170 patients who underwent revision posterior lumbar fusion, 253 (21.6%) were discharged to an inpatient care facility and 917 (78.4%) were discharged to home. Significant risk factors associated with discharge to inpatient care facility were age 60-69 years (odds ratio [OR] 3.62), age ≥70 years (OR 7.46), female gender (OR 1.61), partially dependent functional health status before surgery (OR 2.94), history of chronic obstructive pulmonary disease (OR 1.92), a length of stay >3 days (OR 3.13), and the occurrence of any predischarge complication (OR 4.10). Discharge to inpatient care facilities versus home was associated with a higher risk of experiencing any postdischarge complication (8.3% vs. 3.2%; OR 2.2).
Providers should understand the need of construction of care pathways and reducing discharge to inpatient facilities to mitigate the risks of experiencing adverse outcomes and consequently reduce the financial burden on the health care system.
近期文献表明，选择性初次腰椎和颈椎融合术后在住院机构接受出院后护理与更差的预后相关。尚无研究探讨翻修后路腰椎融合术后出院至住院机构的危险因素及出院后相关预后。
使用当前手术操作术语代码对2012 - 2016年美国外科医师学会-国家外科质量改进计划进行查询，这些代码包括后路腰椎融合术（22630、22633、22614）以及翻修术的当前手术操作术语代码 - 22830（脊柱融合探查）、22849（脊柱固定装置重新插入）、22850（后路非节段性器械移除）和22852（后路节段性器械移除）。
在1170例行翻修后路腰椎融合术的患者中，253例（21.6%）出院至住院护理机构，917例（78.4%）出院回家。与出院至住院护理机构相关的显著危险因素包括年龄60 - 69岁（比值比[OR] 3.62）、年龄≥70岁（OR 7.46）、女性（OR 1.61）、术前部分依赖的功能健康状况（OR 2.94）、慢性阻塞性肺疾病史（OR 1.92）、住院时间>3天（OR 3.13）以及任何出院前并发症的发生（OR 4.10）。出院至住院护理机构与出院后发生任何并发症的较高风险相关（8.3%对3.2%；OR 2.2）。
医疗服务提供者应了解构建护理路径以及减少出院至住院机构的必要性，以降低不良结局的风险，从而减轻医疗保健系统的经济负担。
