1Department of Neurosurgery, Rush University Medical Center, Chicago.
2Chicago Medical School, North Chicago, Illinois.
J Neurosurg Spine. 2019 Mar 29;31(1):70-75. doi: 10.3171/2019.1.SPINE181019. Print 2019 Jul 1.
With the costs related to the United States medical system constantly rising, efforts are being made to turn traditional inpatient procedures into outpatient same-day surgeries. In this study the authors looked at the various comorbidities and perioperative complications and their impact on readmission rates of patients undergoing outpatient versus inpatient 3- and 4-level anterior cervical discectomy and fusion (ACDF).
This was a retrospective study of 337 3- and 4- level ACDF procedures in 332 patients (5 patients had both primary and revision surgeries that were included in this total of 337 procedures) between May 2012 and June 2017. In total, 331 procedures were analyzed, as 6 patients were lost to follow-up. Outpatient surgery was performed for 299 procedures (102 4-level procedures and 197 3-level procedures), and inpatient surgery was performed for 32 procedures (11 4-level procedures and 21 3-level procedures). Age, sex, comorbidities, number of fusion levels, pain level, and perioperative complications were compared between both cohorts.
Analysis was performed for 331 3- and 4-level ACDF procedures done at 6 different hospitals. The overall 30-day readmission rate was 1.2% (outpatient 3 [1.0%] vs inpatient 1 [3.1%], p = 0.847). Outpatients had increased readmission risk, with comorbidities of coronary artery disease (OR 1.058, p = 0.039), autoimmune disease (OR 1.142, p = 0.006), diabetes (OR 1.056, p = 0.001), and chronic kidney disease (OR 0.933, p = 0.035). Perioperative complications of delirium (OR 2.709, p < 0.001) and surgical site infection (OR 2.709, p < 0.001) were associated with increased risk of 30-day hospital readmission in outpatients compared to inpatients.
This study demonstrates the safety and effectiveness of 3- and 4-level ACDF surgery, although various comorbidities and perioperative complications may lead to higher readmission rates. Patient selection for outpatient 3- and 4-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection.
随着美国医疗系统相关成本的不断上升，人们正在努力将传统的住院手术转变为门诊当天手术。在这项研究中，作者研究了各种合并症和围手术期并发症及其对门诊和住院 3 级和 4 级前路颈椎间盘切除术和融合术（ACDF）患者再入院率的影响。
这是一项回顾性研究，纳入了 2012 年 5 月至 2017 年 6 月间 332 名患者的 337 例 3 级和 4 级 ACDF 手术（5 名患者同时进行了原发性和修正手术，总计 337 例手术）。总共分析了 331 例手术，因为有 6 名患者失访。299 例手术采用门诊手术（102 例 4 级手术和 197 例 3 级手术），32 例手术采用住院手术（11 例 4 级手术和 21 例 3 级手术）。比较了两组患者的年龄、性别、合并症、融合节段数、疼痛程度和围手术期并发症。
在 6 家不同的医院进行了 331 例 3 级和 4 级 ACDF 手术分析。总的 30 天再入院率为 1.2%（门诊 3 例[1.0%]与住院 1 例[3.1%]，p = 0.847）。门诊患者的再入院风险增加，伴有冠状动脉疾病（OR 1.058，p = 0.039）、自身免疫性疾病（OR 1.142，p = 0.006）、糖尿病（OR 1.056，p = 0.001）和慢性肾脏病（OR 0.933，p = 0.035）等合并症。与住院患者相比，门诊患者发生谵妄（OR 2.709，p < 0.001）和手术部位感染（OR 2.709，p < 0.001）等围手术期并发症与 30 天住院再入院风险增加相关。
本研究表明 3 级和 4 级 ACDF 手术是安全有效的，尽管各种合并症和围手术期并发症可能导致更高的再入院率。门诊 3 级和 4 级 ACDF 病例的患者选择可能在这些手术在门诊环境中的安全性方面发挥作用，但需要进一步研究以准确确定哪些因素对适当选择最相关。
