Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Department of Neurosurgery, University of California, San Francisco, California, USA.
World Neurosurg. 2020 Jun;138:e336-e344. doi: 10.1016/j.wneu.2020.02.117. Epub 2020 Feb 28.
Regional differences in outcomes after spine surgery are poorly understood. We assessed disability and quality-of-life outcomes by geographic region in the United States using the NeuroPoint Alliance Quality Outcomes Database.
We queried the prospective Quality Outcomes Database patient registry to identify patients who underwent elective 1- or 2-level lumbar surgery for grade I degenerative spondylolisthesis from July 2014 through June 2016. Primary outcome measures included Oswestry Disability Index (ODI) and EuroQOL-5D (EQ-5D) reported at 24 months postoperatively. Differences in EQ-5D and ODI were compared across geographic regions of the United States (Northeast, Midwest, South, West).
We identified 608 patients from 12 centers who underwent surgery. Of these, 517 (85.0%) had ODI data and 492 (80.9%) had EQ-5D data at 24 months. Southern states had the largest representation (304 patients; 5 centers), followed by Northeastern (114 patients; 3 centers), Midwestern (96 patients; 2 centers), and Western (94 patients; 2 centers) states. Baseline ODI scores were significantly different among regions, with the South having the greatest baseline disability burden (Northeast: 40.9 ± 16.9, South: 51.2 ± 15.8, Midwest: 40.9 ± 17.8, West: 45.0 ± 17.1, P < 0.001). The change in ODI at 24 months postoperatively was significantly different among regions, with the South showing the greatest ODI improvement (Northeast: -21.1 ± 18.2, South: -26.5 ± 20.2, Midwest: -18.2 ± 22.9, West: -21.7 ± 19.6, P < 0.001). All regions had ≥60% achievement of the minimum clinically important difference in ODI at 24 months postoperatively. No regional differences were observed for EQ-5D.
Significant regional variation exists for disability outcomes, but not quality of life, at 24 months after spinal surgery for grade I degenerative spondylolisthesis.
脊柱手术后的结果存在地区差异，但人们对此知之甚少。我们使用神经点联盟质量结果数据库（NeuroPoint Alliance Quality Outcomes Database），评估了美国不同地区的残疾和生活质量结果。
我们查询了前瞻性质量结果数据库患者登记处，以确定 2014 年 7 月至 2016 年 6 月期间因 I 级退行性脊椎滑脱接受单或双节段腰椎手术的择期患者。主要结果测量包括术后 24 个月的 Oswestry 残疾指数（Oswestry Disability Index，ODI）和欧洲五维健康量表（EuroQOL-5D，EQ-5D）。
我们从 12 个中心中确定了 608 名接受手术的患者。其中，517 名（85.0%）在 24 个月时有 ODI 数据，492 名（80.9%）有 EQ-5D 数据。南部州的代表性最大（304 例；5 个中心），其次是东北部（114 例；3 个中心）、中西部（96 例；2 个中心）和西部（94 例；2 个中心）。区域间的基线 ODI 评分存在显著差异，南部地区的残疾负担最大（东北部：40.9 ± 16.9，南部：51.2 ± 15.8，中西部：40.9 ± 17.8，西部：45.0 ± 17.1，P < 0.001）。术后 24 个月 ODI 的变化在区域间存在显著差异，南部地区的 ODI 改善最大（东北部：-21.1 ± 18.2，南部：-26.5 ± 20.2，中西部：-18.2 ± 22.9，西部：-21.7 ± 19.6，P < 0.001）。所有地区在术后 24 个月时 ODI 均有≥60%达到最小临床重要差异。EQ-5D 无区域差异。
在 I 级退行性脊椎滑脱脊柱手术后 24 个月时，残疾结果存在显著的区域差异，但生活质量无差异。
