使用国家级数据库对住院和门诊颈椎前路椎间盘置换的结果及成本进行分析。

Analysis of Outcomes and Cost of Inpatient and Ambulatory Anterior Cervical Disk Replacement Using a State-level Database.

作者信息

Purger David A, Pendharkar Arjun V, Ho Allen L, Sussman Eric S, Veeravagu Anand, Ratliff John K, Desai Atman M

机构信息

Department of Neurosurgery, Stanford University, Stanford, CA.

出版信息

Clin Spine Surg. 2019 Oct;32(8):E372-E379. doi: 10.1097/BSD.0000000000000840.

DOI:10.1097/BSD.0000000000000840

PMID:31180992

Abstract

BACKGROUND

Outpatient cervical artificial disk replacement (ADR) is a promising candidate for cost reduction. Several studies have demonstrated low overall complications and minimal readmission in anterior cervical procedures.

OBJECTIVE

The objective of this study was to compare clinical outcomes and cost associated between inpatient and ambulatory setting ADR.

MATERIALS AND METHODS

Outcomes and cost were retrospectively analyzed for patients undergoing elective ADR in California, Florida, and New York from 2009 to 2011 in State Inpatient and Ambulatory Databases.

RESULTS

A total of 1789 index ADR procedures were identified in the inpatient database (State Inpatient Databases) compared with 370 procedures in the ambulatory cohort (State Ambulatory Surgery and Services Databases). Ambulatory patients presented to the emergency department 19 times (5.14%) within 30 days of the index procedure compared with 4.2% of inpatients. Four unique patients underwent readmission within 30 days in the ambulatory ADR cohort (1% total) compared with 2.2% in the inpatient ADR group. No ambulatory ADR patients underwent a reoperation within 30 days. Of the inpatient ADR group, 6 unique patients underwent reoperation within 30 days (0.34%, Charlson Comorbidity Index zero=0.28%, Charlson Comorbidity Index>0=0.6%). There was no significant difference in emergency department visit rate, inpatient readmission rate, or reoperation rates within 30 days of the index procedure between outpatient or inpatient ADR. Outpatient ADR is noninferior to inpatient ADR in all clinical outcomes. The direct cost was significantly lower in the outpatient ADR group ($11,059 vs. 17,033; P<0.001). The 90-day cumulative charges were significantly lower in the outpatient ADR group (mean $46,404.03 vs. $80,055; P<0.0001).

CONCLUSIONS

ADR can be performed in an ambulatory setting with comparable morbidity, readmission rates, and lower costs, to inpatient ADR.

摘要

背景

门诊颈椎人工椎间盘置换术（ADR）是降低成本的一个有前景的选择。多项研究表明，颈椎前路手术的总体并发症发生率较低，再入院率也很低。

目的

本研究的目的是比较住院和门诊环境下ADR的临床结果和相关成本。

材料与方法

对2009年至2011年在加利福尼亚州、佛罗里达州和纽约州接受择期ADR的患者在州住院数据库和门诊数据库中的结果及成本进行回顾性分析。

结果

在住院数据库（州住院数据库）中确定了总共1789例初次ADR手术，而门诊队列（州门诊手术和服务数据库）中有370例。门诊患者在初次手术后30天内19次（5.14%）到急诊科就诊，住院患者为4.2%。门诊ADR队列中有4例（共1%）在30天内再次入院，住院ADR组为2.2%。没有门诊ADR患者在30天内接受再次手术。在住院ADR组中，有6例（0.34%，查尔森合并症指数为零=0.28%，查尔森合并症指数>0=0.6%）在30天内接受再次手术。门诊或住院ADR在初次手术后30天内的急诊科就诊率、住院再入院率或再次手术率没有显著差异。门诊ADR在所有临床结果上不劣于住院ADR。门诊ADR组的直接成本显著更低（11,059美元对17,033美元；P<0.001）。门诊ADR组的90天累计费用显著更低（平均46,404.03美元对80,055美元；P<0.0001）。