非出院地作为行前路颈椎间盘切除融合术患者不良事件和再入院的独立危险因素。

Nonhome Discharge as an Independent Risk Factor for Adverse Events and Readmission in Patients Undergoing Anterior Cervical Discectomy and Fusion.

机构信息

Departments of Neurosurgery.

Anesthesiology, Perioperative, and Pain Medicine.

出版信息

Clin Spine Surg. 2020 Dec;33(10):E454-E459. doi: 10.1097/BSD.0000000000000961.

DOI:10.1097/BSD.0000000000000961

PMID:32101991

Abstract

STUDY DESIGN

A retrospective study of a prospectively collected cohort.

OBJECTIVE

To characterize a cohort of patients who underwent anterior cervical discectomy and fusion (ACDF) and examine whether nonhome discharge (NHD) is associated with postdischarge adverse events (AEs) and readmission.

SUMMARY OF THE BACKGROUND DATA

Predictors of NHD have been elucidated in the spine surgery literature, and NHD has been tied to poor outcomes in the joint arthroplasty literature, but no such analysis exists for patients undergoing ACDF.

MATERIALS AND METHODS

All patients who underwent ACDF from 2012 to 2015 in the National Surgical Quality Improvement Program were identified. Those who underwent concomitant posterior cervical operations were excluded. Patients who were discharged to home were compared with those discharged to nonhome destinations on the basis of demographics and outcomes. Multivariable models were created to assess whether NHD was an independent risk factor for postdischarge AEs and readmission.

RESULTS

NHD patients were significantly older (63.96 vs. 53.57 y; P<0.0001), more functionally dependent (13.87% vs. 1.09%; P<0.0001), more likely to have body mass index >40 (9.38% vs. 7.51%; P=0.004), and more likely to have ASA Class >2 (77.89% vs. 39.57%; P<0.0001). Patients who underwent NHD were significantly more likely to suffer severe AEs (14.44% vs. 0.93%; P<0.0001), minor AEs (7.22% vs. 0.24%; P<0.0001), and infectious complications (3.58% vs. 0.13%; P<0.0001) before discharge. When examining AEs after discharge, patients who underwent NHD were more likely to suffer severe AEs (6.37% vs. 1.34%; P<0.0001), minor AEs (4.09% vs. 0.74%; P<0.0001), death (1.25% vs. 0.07%; P<0.0001), and unplanned readmission (10.12% vs. 3.06%; P<0.0001). In adjusted analysis, NHD was found to independently predict severe AEs after discharge (odds ratio, 2.40; 95% confidence interval, 1.87-3.07; P<0.0001) and readmission (odds ratio, 1.77; 95% confidence interval, 1.46-2.14; P<0.0001).

CONCLUSIONS

NHD patients were significantly sicker than those discharged home. In addition, NHD is associated with higher rates of postdischarge complications.

摘要

研究设计

一项前瞻性收集队列的回顾性研究。

目的

描述接受颈椎前路椎间盘切除融合术（ACDF）的患者队列，并研究非家庭出院（NHD）是否与出院后不良事件（AE）和再入院相关。

背景资料概述

脊柱外科文献已经阐明了 NHD 的预测因素，并且 NHD 与关节置换术文献中的不良结果有关，但对于接受 ACDF 的患者，尚无此类分析。

材料和方法

从国家手术质量改进计划中确定了 2012 年至 2015 年期间接受 ACDF 的所有患者。排除同时接受颈椎后路手术的患者。根据人口统计学和结果，将出院至家庭的患者与出院至非家庭目的地的患者进行比较。建立多变量模型，以评估 NHD 是否是出院后 AE 和再入院的独立危险因素。

结果

NHD 患者明显更年长（63.96 岁 vs. 53.57 岁；P<0.0001）、功能依赖性更高（13.87% vs. 1.09%；P<0.0001）、更有可能 BMI>40（9.38% vs. 7.51%；P=0.004），且更有可能 ASA 分级>2（77.89% vs. 39.57%；P<0.0001）。NHD 患者发生严重 AE（14.44% vs. 0.93%；P<0.0001）、轻微 AE（7.22% vs. 0.24%；P<0.0001）和感染性并发症（3.58% vs. 0.13%；P<0.0001）的可能性明显更高。在检查出院后的 AE 时，NHD 患者发生严重 AE（6.37% vs. 1.34%；P<0.0001）、轻微 AE（4.09% vs. 0.74%；P<0.0001）、死亡（1.25% vs. 0.07%；P<0.0001）和计划外再入院（10.12% vs. 3.06%；P<0.0001）的可能性更高。在调整分析中，NHD 被发现是出院后严重 AE（比值比，2.40；95%置信区间，1.87-3.07；P<0.0001）和再入院（比值比，1.77；95%置信区间，1.46-2.14；P<0.0001）的独立预测因素。