Elsamadicy Aladine A, Koo Andrew B, Lee Megan, Freedman Isaac G, David Wyatt B, Kundishora Adam J, Gorrepati Ramana, Kuzmik Gregory A, Camara-Quintana Joaquin, Qureshi Tariq, Kolb Luis, Laurans Maxwell, Abbed Khalid
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT.
Clin Spine Surg. 2020 Nov;33(9):E434-E441. doi: 10.1097/BSD.0000000000001030.
This is a retrospective cohort study.
The aim of this study was to assess the patient-level risk factors associated with 30- and 90-day unplanned readmissions following elective anterior cervical decompression and fusion (ACDF) or cervical disk arthroplasty (CDA).
For cervical disk pathology, both ACDF and CDA are increasingly performed nationwide. However, relatively little is known about the adverse complications and rates of readmission for ACDF and CDA.
A retrospective cohort study was performed using the Nationwide Readmission Database from the years 2013 to 2015. All patients undergoing either CDA or ACDF were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Unique patient linkage numbers were used to follow patients and to identify 30- and 31-90-day readmission rates. Patients were grouped by no readmission (Non-R), readmission within 30 days (30-R), and readmission within 31-90 days (90-R).
There were a total of 13,093 index admissions with 856 (6.5%) readmissions [30-R: n=532 (4.0%); 90-R: n=324 (2.5%)]. Both overall length of stay and total cost were greater in the 30-R cohort compared with 90-R and Non-R cohorts. The most prevalent 30- and 90-day complications seen among the readmitted cohorts were infection, genitourinary complication, and device complication. On multivariate regression analysis, age, Medicaid status, medium and large hospital bed size, deficiency anemia, and any complication during index admission were independently associated with increased 30-day readmission. Whereas age, large hospital bed size, coagulopathy, and any complication during the initial hospitalization were independently associated with increased 90-day readmission.
Our nationwide study identifies the 30- and 90-day readmission rates and several patient-related risk factors associated with unplanned readmission after common anterior cervical spine procedures.
Level III.
这是一项回顾性队列研究。
本研究旨在评估择期颈椎前路减压融合术（ACDF）或颈椎间盘置换术（CDA）后30天和90天非计划再入院相关的患者层面危险因素。
对于颈椎间盘病变，ACDF和CDA在全国范围内的实施越来越多。然而，关于ACDF和CDA的不良并发症和再入院率，人们了解得相对较少。
使用2013年至2015年的全国再入院数据库进行回顾性队列研究。使用国际疾病分类第九版临床修订编码系统识别所有接受CDA或ACDF的患者。使用唯一的患者关联号码跟踪患者并确定30天和31 - 90天的再入院率。患者分为无再入院（非R组）、30天内再入院（30 - R组）和31 - 90天内再入院（90 - R组）。
共有13093例初次入院患者，其中856例（6.5%）再入院[30 - R组：n = 532例（4.0%）；90 - R组：n = 324例（2.5%）]。与90 - R组和非R组相比，30 - R组的总体住院时间和总费用更高。再入院队列中最常见的30天和90天并发症是感染、泌尿生殖系统并发症和器械并发症。多因素回归分析显示，年龄、医疗补助状态、中型和大型医院床位规模、缺铁性贫血以及初次入院期间的任何并发症与30天再入院增加独立相关。而年龄、大型医院床位规模、凝血病以及初次住院期间的任何并发症与90天再入院增加独立相关。
我们的全国性研究确定了常见颈椎前路手术后30天和90天的再入院率以及与非计划再入院相关的几个患者相关危险因素。
三级。
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