Menga Emmanuel N, Bernstein David N, Thirukumaran Caroline, McCormick Sekinat K, Rubery Paul T, Mesfin Addisu
Department of Orthopaedic Surgery, University of Rochester, Rochester, New York.
Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, Texas.
Int J Spine Surg. 2020 Jun 30;14(3):382-390. doi: 10.14444/7050. eCollection 2020 Jun.
There is a paucity of literature examining surgical trends and outcomes in both child and adult cerebral palsy (CP) patients. We aimed to evaluate surgical trends, complications, length of stay, and charges for spinal deformity surgery in CP patients.
Using the Nationwide Inpatient Sample (NIS) from 2001 to 2013, patients with CP scoliosis who underwent spinal fusion surgery were identified. Patient characteristics and comorbidities were recorded. Trends in spinal fusion approaches were grouped as anterior (ASF), posterior (PSF), or combined anterior-posterior (ASF/PSF). Complication rates, length of stay, and charges for each approach were analyzed. Bivariate analyses using adjusted Wald tests and multivariate analyses using linear (logarithmic transformation) and logistic regressions were performed.
Of the 5191 adult CP patients who underwent spinal fusion the majority underwent PSF (86.5%), followed by the ASF/PSF approach (9.3%). The rate of PSF for cerebral palsy patients with spinal deformity increased significantly per 1 million people in the US population (0.90 to 1.30; = .048). Complication rate, hospital length of stay, and charges were higher for patients undergoing ASF/PSF ( < .05). The overall complication rate for all surgical approaches was 25.7%. Patient comorbidities and combined ASF/PSF increased the odds of complication. Combined ASF/PSF was also associated with an increased length of stay and charges.
Combined ASF/PSF in patients with CP accounted for only 9.3% of surgical cases but was associated with the longest hospital stay, highest charges, and increased complications. Further scrutiny of the surgical indications and preoperative risk stratification should be undertaken to minimize complications, reduce length of stay, and decrease charges for CP patients undergoing spinal fusion.
IV.
关于儿童和成人脑瘫（CP）患者手术趋势及结果的文献较少。我们旨在评估CP患者脊柱畸形手术的手术趋势、并发症、住院时间和费用。
利用2001年至2013年的全国住院患者样本（NIS），确定接受脊柱融合手术的CP脊柱侧弯患者。记录患者特征和合并症。脊柱融合方法的趋势分为前路（ASF）、后路（PSF）或前后联合（ASF/PSF）。分析每种方法的并发症发生率、住院时间和费用。采用调整后的Wald检验进行双变量分析，采用线性（对数转换）和逻辑回归进行多变量分析。
在5191例接受脊柱融合手术 的成年CP患者中，大多数采用PSF（86.5%），其次是ASF/PSF方法（9.3%）。美国人群中每100万人中患有脊柱畸形 的脑瘫患者的PSF发生率显著增加（从0.90增至1.30；P = 0.048）。接受ASF/PSF的患者并发症发生率、住院时间和费用更高（P < 0.05）。所有手术方法的总体并发症发生率为25.7%。患者合并症和ASF/PSF联合使用增加了并发症的几率。ASF/PSF联合使用还与住院时间延长和费用增加有关。
CP患者中ASF/PSF联合使用仅占手术病例的9.3%，但与最长住院时间、最高费用和并发症增加有关。应进一步仔细审查手术适应症和术前风险分层，以尽量减少并发症、缩短住院时间并降低接受脊柱融合手术的CP患者的费用。
IV级。
