Renfree Sean P, Makovicka Justin L, Chung Andrew S
Duke University Graduate School, Durham, NC, USA.
Orthopedic Surgery Residency, Mayo Clinic Arizona, Phoenix, Arizona, USA.
J Spine Surg. 2019 Dec;5(4):475-482. doi: 10.21037/jss.2019.10.09.
Anterior cervical discectomy and fusion (ACDF) is well-tolerated by most patients and commonly necessitates only a short hospital admission. Surgical delay after hospital admission, however, may result in longer hospital stays, consequently increasing hospital resource utilization. The current study evaluates risk factors for surgical delay in patients undergoing elective ACDF.
A retrospective analysis of ACS-NSQIP data from 2006-2015 was performed. Patients undergoing elective ACDF were selected using current procedural terminology (CPT) codes (22251, 22252, 22554). A surgical delay was defined as surgery that occurred one day or later after initial hospital admission. Differences in outcomes between the non-delayed and delayed cohorts were evaluated with univariate analysis. Multivariate logistic regression was performed to identify risk factors for surgical delay.
There were a total of 771 (2.0%) surgical delays out of 39,371 patients undergoing elective ACDF from 2006-2015. Multivariate analysis found partially dependent functional status (OR 5.88; 95% CI: 4.48-7.71; P<0.001), totally dependent functional status (OR 18.22; 95% CI: 9.60-34.59; P<0.001), ASA class 4 (OR 2.73; 95% CI: 1.70-4.38; P<0.001), bleeding disorders (OR 1.75; 95% CI: 1.08-2.85; P=0.024), male sex (OR 1.19; 95% CI: 1.03-1.38; P=0.019), and chronic steroid use (OR 1.76; 95% CI: 1.30-2.37; P<0.001) as independent predictors of delay. Univariate analysis found surgical delay was associated with a higher rate of post-operative major adverse events (4.8% 1.1%; P<0.001), mortality (1.0% 0.2%; P<0.001) and greater than five-fold increase in total length of stay (9.52 1.65 days; P<0.001).
Impaired pre-operative functional status, a higher comorbidity burden, and chronic steroid use are risk factors for surgical delay, increased complications, and length of stay in patients undergoing elective ACDF. This is helpful information to consider given a rising incidence of cervical fusions in the Medicare population, a wide variation in costs, and increasing popularity of bundled-payment models.
大多数患者对颈椎前路椎间盘切除融合术（ACDF）耐受性良好，通常只需短期住院。然而，入院后手术延迟可能导致住院时间延长，从而增加医院资源利用。本研究评估择期ACDF患者手术延迟的风险因素。
对2006年至2015年美国外科医师协会国家外科质量改进计划（ACS-NSQIP）数据进行回顾性分析。使用当前程序术语（CPT）编码（22251、22252、22554）选择择期ACDF患者。手术延迟定义为初次入院一天或更晚进行的手术。采用单因素分析评估非延迟组和延迟组之间的结果差异。进行多因素逻辑回归以确定手术延迟的风险因素。
2006年至2015年，39371例择期ACDF患者中共有771例（2.0%）发生手术延迟。多因素分析发现部分依赖功能状态（比值比[OR]5.88；95%置信区间[CI]：4.48 - 7.71；P<0.001）、完全依赖功能状态（OR 18.22；95% CI：9.60 - 34.59；P<0.001）、美国麻醉医师协会（ASA）分级4级（OR 2.73；95% CI：1.70 - 4.38；P<0.001）、出血性疾病（OR 1.75；95% CI：1.08 - 2.85；P = 0.024）、男性（OR 1.19；95% CI：1.03 - 1.38；P = 0.019）和长期使用类固醇（OR 1.76；95% CI：1.30 - 2.37；P<0.001）是延迟的独立预测因素。单因素分析发现手术延迟与术后严重不良事件发生率较高（4.8%对1.1%；P<0.001）、死亡率（1.0%对0.2%；P<0.001）以及住院总时长增加超过五倍（9.52天对1.65天；P<0.001）相关。
术前功能状态受损、较高的合并症负担和长期使用类固醇是择期ACDF患者手术延迟、并发症增加和住院时间延长的风险因素。鉴于医疗保险人群中颈椎融合术发病率上升、成本差异巨大以及捆绑支付模式日益普及，这是需要考虑的有用信息。
3级
