Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
Evergreen Hospital Neuroscience Institute, Kirkland, Washington, USA.
World Neurosurg. 2020 Sep;141:e976-e988. doi: 10.1016/j.wneu.2020.06.107. Epub 2020 Jun 22.
To identify factors impacting long-term complications, reoperations, readmission rates, and health care utilization in patients with osteoporosis (OP) following lumbar fusions.
We used International Classification of Disease, Ninth Revision, International Classification of Disease, Tenth Revision , and Current Procedural Terminology codes to extract data from MarketScan (2000-2016). Patients undergoing lumbar spine fusion were divided into 2 groups based on preoperative diagnosis: OP or non-OP. We used multivariable generalized linear regression models to analyze outcomes of interest (reoperation rates, readmissions, complications, health care utilization) at 1, 6, 12, and 24 months after discharge.
MarketScan identified 116,749 patients who underwent lumbar fusion with ≥24 months of follow-up; 6% had OP. OP patients had a higher incidence of complications (14% vs. 9%); were less likely to be discharged home (77% vs. 86%, P < 0.05); had more new fusions or refusions at 6 months (2.9% vs. 2.1%), 12 months (5% vs. 3.8%), and 24 months (8.5% vs. 7.4%); incurred more outpatient services at 12 months (80 vs. 61) and 24 months (148 vs. 115); and incurred higher overall costs at 12 months ($22,932 vs. $17,017) and 24 months ($48,379 vs. $35,888). Elderly OP patients (>65 years old) who underwent multilevel lumbar fusions had longer hospitalization, had higher complication rates, and incurred lower costs at 6, 12, and 24 months compared with young non-OP patients who underwent single-level lumbar fusion.
Patients of all ages with OP had higher complication rates and required revision surgeries at 6, 12, and 24 months compared with non-OP patients. Elderly OP patients having multilevel lumbar fusions were twice as likely to have complications and lower health care utilization compared with younger non-OP patients who underwent single-level fusion.
确定影响骨质疏松症（OP）患者腰椎融合术后长期并发症、再次手术、再入院率和医疗保健利用的因素。
我们使用国际疾病分类第 9 版、国际疾病分类第 10 版和当前操作术语代码从 MarketScan（2000-2016 年）中提取数据。根据术前诊断将接受腰椎融合术的患者分为 2 组：OP 或非-OP。我们使用多变量广义线性回归模型分析出院后 1、6、12 和 24 个月时感兴趣的结局（再次手术率、再入院率、并发症、医疗保健利用）。
MarketScan 确定了 116749 例接受随访时间≥24 个月的腰椎融合术患者；其中 6%患有 OP。OP 患者的并发症发生率更高（14% vs. 9%）；出院回家的可能性较低（77% vs. 86%，P<0.05）；6 个月（2.9% vs. 2.1%）、12 个月（5% vs. 3.8%）和 24 个月（8.5% vs. 7.4%）时出现更多新融合或再融合；12 个月（80 次 vs. 61 次）和 24 个月（148 次 vs. 115 次）门诊服务更多；12 个月（22932 美元 vs. 17017 美元）和 24 个月（48379 美元 vs. 35888 美元）总费用更高。接受多节段腰椎融合术的老年 OP 患者（>65 岁）与年轻的非 OP 患者相比，住院时间更长，并发症发生率更高，6、12 和 24 个月时的费用更低，他们接受了单节段腰椎融合术。
与非 OP 患者相比，所有年龄段的 OP 患者在 6、12 和 24 个月时并发症发生率更高，需要进行翻修手术。接受多节段腰椎融合术的老年 OP 患者发生并发症的可能性是年轻非 OP 患者的两倍，而健康保健利用率较低，后者接受了单节段融合术。
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