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骨科与神经外科——不同专业行择期单节段至双节段后路腰椎融合术患者 90 天并发症和费用的理解

Orthopedic versus Neurosurgery-Understanding 90-Day Complications and Costs in Patients Undergoing Elective 1-Level to 2-Level Posterior Lumbar Fusions by Different Specialties.

机构信息

Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

出版信息

World Neurosurg. 2019 Nov;131:e447-e453. doi: 10.1016/j.wneu.2019.07.194. Epub 2019 Aug 12.

Abstract

BACKGROUND

Lumbar fusions are routinely performed by either orthopedic or neurologic spine surgeons. Controversy still exists as to whether a provider's specialty (orthopedic vs. neurosurgery) influences outcomes.

METHODS

The 2007-2015Q2 Humana Commercial Database was queried using Current Procedural Terminology codes (22612, 22614, 22630, 22632, 22633 and 22634) to identify patients undergoing elective 1-to-2 level posterior lumbar fusions (PLFs) with active enrollment up to 90 days after procedure. Ninety-day complication rates were calculated for the 2 specialties. The surgical and 90-day resource utilization costs for the 2 groups were compared, by studying average reimbursements for acute-care and post-acute-care categories. Ninety-day complications and costs were compared using multivariable logistic and linear regression analyses.

RESULTS

A total of 10,509 patients (5523 orthopedic and 4986 neurosurgery) underwent an elective 1-to-2 level PLF during the period. With the exception of a significantly lower odds of wound complications (odds ratio, 0.81) and a higher odds of dural tears (odds ratio, 1.29) in elective PLFs performed by orthopedic surgeons, no statistically strong differences were seen in 90-day complication rates between the 2 groups. Total 90-day costs were also similar between orthopedic surgeons and neurosurgeons, with the only exception being that surgeon reimbursement was lower for orthopedic surgery versus neurosurgery ($1202 vs. $1372; P < 0.001).

CONCLUSIONS

It seems that a provider's specialty does not largely influence 90-day surgical outcomes and costs after elective PLFs. The results of the study promote the formation and acceptance of dual training pathways for entry into spine surgery.

摘要

背景

腰椎融合术通常由骨科或神经外科脊柱外科医生进行。目前仍存在争议,即提供者的专业(骨科与神经外科)是否会影响结果。

方法

使用当前手术程序代码(22612、22614、22630、22632、22633 和 22634),对 2007 年至 2015 年第二季度的 Humana 商业数据库进行查询,以确定接受择期 1 至 2 级后路腰椎融合术(PLF)的患者,术后 90 天内有活跃登记。计算这两个专业的 90 天并发症发生率。通过研究急性护理和康复后护理类别的平均报销费用,比较两组的手术和 90 天资源利用成本。使用多变量逻辑和线性回归分析比较 90 天并发症和成本。

结果

在此期间,共有 10509 名患者(5523 名骨科和 4986 名神经外科)接受了择期 1 至 2 级 PLF。除了骨科医生进行的择期 PLF 中伤口并发症的可能性明显较低(优势比为 0.81)和硬膜撕裂的可能性较高(优势比为 1.29)外,两组之间 90 天并发症发生率没有统计学上的显著差异。骨科医生和神经外科医生的总 90 天费用也相似,唯一的例外是骨科手术的医生报销低于神经外科手术(1202 美元与 1372 美元;P<0.001)。

结论

似乎提供者的专业并不在很大程度上影响择期 PLF 后的 90 天手术结果和成本。该研究的结果促进了脊柱外科双培训途径的形成和接受。

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