Katz Austen David, Perfetti Dean Cosmo, Job Alan, Willinger Max, Goldstein Jeffrey, Kiridly Daniel, Olivares Peter, Satin Alexander, Essig David
North Shore University Hospital-25049Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY, USA.
51718Texas Back Institute, Plano, TX, USA.
Global Spine J. 2021 Jun;11(5):640-648. doi: 10.1177/2192568220941458. Epub 2020 Jul 31.
Retrospective cohort study.
Spine surgery has been increasingly performed in the outpatient setting, providing greater control over cost, efficiency, and resource utilization. However, research evaluating the safety of this trend is limited. The objective of this study is to compare 30-day readmission, reoperation, and morbidity for patients undergoing lumbar disc arthroplasty (LDA) in the inpatient versus outpatient settings.
Patients who underwent LDA from 2005 to 2018 were identified using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Regression was utilized to compare readmission, reoperation, and morbidity between surgical settings, and to evaluate for predictors thereof.
We identified 751 patients. There were no significant differences between inpatient and outpatient LDA in rates of readmission, reoperation, or morbidity on univariate or multivariate analyses. There were also no significant differences in rates of specific complications. Inpatient operative time (138 ± 75 minutes) was significantly ( < .001) longer than outpatient operative time (106 ± 43 minutes). In multivariate analysis, diabetes ( < .001, OR = 7.365), baseline dyspnea ( = .039, OR = 6.447), and increased platelet count ( = .048, OR = 1.007) predicted readmission. Diabetes ( = .016, OR = 6.533) and baseline dyspnea ( = .046, OR = 13.814) predicted reoperation. Baseline dyspnea ( = .021, OR = 8.188) and ASA (American Society of Anesthesiologists) class ≥3 ( = .014, OR = 3.515) predicted morbidity. Decreased hematocrit ( = .008) and increased operative time ( = .003) were associated with morbidity in univariate analysis, but not in multivariate analysis.
Readmission, reoperation, and morbidity were statistically similar between surgical setting, indicating that LDA can be safely performed in the outpatient setting. Higher ASA class and specific comorbidities predicted poorer 30-day outcomes. These findings can guide choice of surgical setting given specific patient factors.
回顾性队列研究。
脊柱手术越来越多地在门诊环境中进行，这使得对成本、效率和资源利用有了更好的控制。然而，评估这种趋势安全性的研究有限。本研究的目的是比较腰椎间盘置换术（LDA）患者在住院和门诊环境下的30天再入院率、再次手术率和发病率。
使用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库识别2005年至2018年接受LDA的患者。采用回归分析比较手术环境之间的再入院率、再次手术率和发病率，并评估其预测因素。
我们识别出751例患者。单因素或多因素分析显示，住院和门诊LDA在再入院率、再次手术率或发病率方面无显著差异。特定并发症的发生率也无显著差异。住院手术时间（138±75分钟）显著长于门诊手术时间（106±43分钟）（P<0.001）。多因素分析中，糖尿病（P<0.001，OR=7.365）、基线呼吸困难（P=0.039，OR=6.447）和血小板计数升高（P=0.048，OR=1.007）可预测再入院。糖尿病（P=0.016，OR=6.533）和基线呼吸困难（P=0.046，OR=13.814）可预测再次手术。基线呼吸困难（P=0.021，OR=8.188）和美国麻醉医师协会（ASA）分级≥3（P=0.014，OR=3.515）可预测发病率。单因素分析中，血细胞比容降低（P=0.008）和手术时间延长（P=0.003）与发病率相关，但多因素分析中并非如此。
手术环境之间的再入院率、再次手术率和发病率在统计学上相似，表明LDA可在门诊环境中安全进行。较高的ASA分级和特定合并症预示着30天的预后较差。这些发现可根据特定患者因素指导手术环境的选择。
