Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States.
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States.
Clin Neurol Neurosurg. 2020 Aug;195:105883. doi: 10.1016/j.clineuro.2020.105883. Epub 2020 May 4.
There is a paucity of literature describing the predictors associated with extended length of hospital stay (LOS) for patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy. The aim of this study was to identify the patient- and hospital-level factors associated with extended LOS for patients with cervical spondylotic myelopathy undergoing ACDF.
The National Inpatient Sample database was queried to identify patients with a diagnosis of cervical spondylotic myelopathy undergoing ACDF between 2010 and 2014. Updated trend weights were used to assess patient demographics, comorbidities, complications, LOS, discharge disposition and total cost. Multivariate logistic regression was used to determine the odds ratio for risk-adjusted LOS. The primary outcome was the degree to which patient comorbidities or postoperative complications correlated with extended LOS (>3 days).
We identified 144,514 patients with 29,947 (20.7%) experiencing an extended LOS (Normal LOS: 114,567; Extended LOS: 29,947). Comorbidities were overall significantly higher in the extended LOS cohort compared to the normal LOS cohort. Patients with extended LOS had a significantly greater proportion of blood transfusion (p < 0.001) and 2-3 vertebral levels fused (p < 0.001). The overall complication rates were greater in the extended LOS cohort (Normal LOS: 7.4% vs. Extended LOS: 44.8%, p < 0.001). The extended LOS cohort incurred $14,489 more in total cost (Normal LOS: $15,486 [11,787-20,623] vs. Extended LOS: $29,975 [21,286-45,285], p < 0.001) and had more patients discharged to non-routine locations (p < 0.001) compared to the normal LOS cohort. On multivariate logistic regression, several risk-factors were associated with extended LOS including: age, male gender, Black and Hispanic race, patient income, insurance, multiple comorbidities, blood transfusion, and number of complications. The odds ratio for extended LOS was 5.15 (95% CI: 4.68-5.67) for patients with 1 complication and 25.54 (95% CI: 20.54-31.75) for patients with >1 complication.
Our national cohort study demonstrated multiple patient- and hospital-level factors associated with extended LOS (>3 days) after ACDF for CSM. Specifically, patients with an extended LOS had lower socioeconomic status, higher rate of comorbidities, greater percentage of postoperative complications and non-routine discharges, with greater overall costs. Further investigational studies are necessary to identify quality improvement strategies targeted to better optimizing patients preoperatively and reducing perioperative complications in order to improve quality of patient care and reduce hospital LOS.
目前关于接受颈椎前路椎间盘切除融合术（ACDF）治疗脊髓型颈椎病患者的住院时间延长（LOS）的相关预测因素的文献很少。本研究的目的是确定与接受颈椎前路椎间盘切除融合术（ACDF）治疗的脊髓型颈椎病患者 LOS 延长相关的患者和医院水平因素。
使用国家住院患者样本数据库，对 2010 年至 2014 年期间接受 ACDF 治疗的脊髓型颈椎病患者进行诊断。使用更新的趋势权重评估患者的人口统计学特征、合并症、并发症、 LOS、出院处置和总费用。多变量逻辑回归用于确定风险调整 LOS 的优势比。主要结果是患者合并症或术后并发症与延长 LOS（>3 天）的相关程度。
我们确定了 144514 名患者，其中 29947 名（20.7%）患者 LOS 延长（正常 LOS：114567 名；延长 LOS：29947 名）。与正常 LOS 组相比，延长 LOS 组的合并症总体上明显更高。LOS 延长组的输血比例（p<0.001）和融合 2-3 个椎体水平的比例（p<0.001）明显更高。LOS 延长组的总体并发症发生率更高（正常 LOS：7.4%比延长 LOS：44.8%，p<0.001）。LOS 延长组的总费用增加了 14489 美元（正常 LOS：15486 美元[11487-20623 美元]比 LOS 延长组：29975 美元[21486-45285 美元]，p<0.001），并且有更多的患者出院到非常规地点（p<0.001）与正常 LOS 组相比。在多变量逻辑回归中，一些危险因素与 LOS 延长相关，包括：年龄、男性、黑人和西班牙裔种族、患者收入、保险、多种合并症、输血和并发症数量。有 1 个并发症的患者 LOS 延长的优势比为 5.15（95%CI：4.68-5.67），有>1 个并发症的患者为 25.54（95%CI：20.54-31.75）。
我们的全国队列研究表明，ACDF 治疗后脊髓型颈椎病患者的 LOS 延长与多种患者和医院水平因素有关。具体来说，LOS 延长的患者社会经济地位较低，合并症发生率较高，术后并发症比例较高，非常规出院率较高，总费用较高。需要进一步的研究来确定质量改进策略，旨在更好地优化患者术前状况并减少围手术期并发症，以改善患者护理质量并降低医院 LOS。
