Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Int J Environ Res Public Health. 2020 Feb 19;17(4):1335. doi: 10.3390/ijerph17041335.
Early discharge (ED) has emerged and gained popularity in spine surgery. However, the benefits of ED in lumbar fusion have not yet been validated by large cohort studies. To evaluate the effects of ED on readmissions and reoperations in lumbar fusion, this study utilized a national database to enroll patients who had undergone lumbar fusion surgery at age 50-70 years, and grouped them into an ED group or a comparison group. In the comprehensive follow-up of 180 days post-operation, the two groups were compared. There were 18,008 patients in the cohort, including 2172 in the ED group and 15,836 in the comparison group. The ED group was slightly younger (59.9 vs. 60.7 years, < 0.001), more male predominant (44.9% vs. 36.9%, < 0.001), and had fewer medical comorbidities. The ED group had less incidences of readmission than the comparison group. (Crude hazard ratio = 0.73, and adjusted HR = 0.75, both < 0.001). Overall, the cumulative incidences of readmission in the ED group (9.5%) were lower than those in the comparison group (12.8%, < 0.001), whereas reoperations were insignificantly different (1.5% vs. 1.2%, = 0.189). For patients aged 50-70 years and who require lumbar fusion surgery, ED could yield a 25% reduced risk of readmission for any cause within 180 days post-operation. Since the reoperation rates remained similar, our results suggest that ED may be a promising option for elderly patients undergoing lumbar spinal fusion surgery.
早期出院（ED）在脊柱外科中已经出现并得到了广泛应用。然而，ED 在腰椎融合中的益处尚未得到大型队列研究的验证。为了评估 ED 对腰椎融合患者再入院和再次手术的影响，本研究利用国家数据库纳入了 50-70 岁接受腰椎融合手术的患者，并将其分为 ED 组和对照组。在术后 180 天的综合随访中，比较了两组患者。该队列中有 18008 名患者，其中 ED 组 2172 例，对照组 15836 例。ED 组患者年龄稍小（59.9 岁比 60.7 岁，<0.001），男性居多（44.9%比 36.9%，<0.001），合并症较少。ED 组患者的再入院率低于对照组。（粗风险比=0.73，调整后的 HR=0.75，均<0.001）。总体而言，ED 组患者的再入院累积发生率（9.5%）低于对照组（12.8%，<0.001），但再次手术率无显著差异（1.5%比 1.2%，=0.189）。对于 50-70 岁需要进行腰椎融合手术的患者，ED 可使术后 180 天内任何原因导致的再入院风险降低 25%。由于再次手术率相似，我们的结果表明 ED 可能是老年腰椎融合手术患者的一种有前途的选择。
