Malik Azeem Tariq, Xie Jack, Xi Romi, Yu Elizabeth, Kim Jeffery, Khan Safdar N
Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States.
Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States.
Clin Neurol Neurosurg. 2019 Oct;185:105501. doi: 10.1016/j.clineuro.2019.105501. Epub 2019 Aug 27.
Previous literature has studied overall post-operative outcomes following lumbar fusions. We examined the rates and risk factors for adverse outcomes in patients who are being discharged home.
The 2012-2016 ACS-NSQIP database was used to query for patients undergoing 1- to 2-level posterior lumbar fusions (PLFs) for degenerative spinal pathology. Patients discharged to a destination other than home were removed from the database.
Out of a total of 19,179 home-discharge patients, 546 (2.8%) experienced any adverse event (AAE), 276 experienced a severe adverse event (SAE) and 321 (1.7%) experienced a minor adverse event (MAE). Overall re-admission and re-operation rate in home-discharged patients was 4.4% and 2.5%. Multivariate analysis identified the following predictors for experiencing an AAE - Bleeding disorder (OR 2.25), BMI ≥ 35.0 vs. BMI < 25 (OR 1.96), chronic steroid use (OR 1.89), a LOS > 3 days (OR 1.53), insulin-dependent diabetes mellitus (OR 1.44), hypertension (OR 1.28) and female gender (OR 1.24). Patients with a pre-discharge complication (OR 2.12), bleeding disorders (OR 1.84), chronic steroid use (OR 1.55), age>75 (OR 1.49), age>65 (OR 1.26), history of severe COPD (OR 1.43), total operative time >210 min. (OR 1.26), ASA > II (OR 1.26) and undergoing a 2-level fusion (OR 1.21) were likely to be re-admitted from home.
Providers should utilize the data to risk-stratify and better understand the need of provision of supplemental health-care services, in home-discharged patients, and/or regular clinic follow-up to minimize the rate of adverse events and reduce costs in a bundled-payment environment.
既往文献研究了腰椎融合术后的总体手术结局。我们调查了出院回家患者不良结局的发生率及危险因素。
使用2012 - 2016年美国外科医师学会国家外科质量改进计划（ACS - NSQIP）数据库，查询因退行性脊柱病变接受1至2节段后路腰椎融合术（PLF）的患者。将出院目的地不是回家的患者从数据库中剔除。
在总共19179例出院回家的患者中，546例（2.8%）发生了任何不良事件（AAE），276例发生了严重不良事件（SAE），321例（1.7%）发生了轻微不良事件（MAE）。出院回家患者的总体再入院率和再次手术率分别为4.4%和2.5%。多因素分析确定了以下发生AAE的预测因素——出血性疾病（比值比[OR] 2.25）、体重指数（BMI）≥35.0对比BMI < 25（OR 1.96）、长期使用类固醇（OR 1.89）、住院时间（LOS）> 3天（OR 1.53）、胰岛素依赖型糖尿病（OR 1.44）、高血压（OR 1.28）以及女性（OR 1.24）。有出院前并发症（OR 2.12）、出血性疾病（OR 1.84）、长期使用类固醇（OR 1.55）、年龄>75岁（OR 1.49）、年龄>65岁（OR 1.26）、重度慢性阻塞性肺疾病（COPD）病史（OR 1.43）、总手术时间>210分钟（OR 1.26）、美国麻醉医师协会（ASA）分级>II级（OR 1.26）以及接受2节段融合术（OR 1.21）的患者更有可能从家中再次入院。
医疗服务提供者应利用这些数据进行风险分层，并更好地了解出院回家患者提供补充医疗服务的需求，和/或进行定期门诊随访，以尽量降低不良事件发生率，并在捆绑支付环境中降低成本。
