Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, Annenberg 8th Floor, 1 Gustave Levy Place, New York, NY, 10029, USA.
Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, 10029, USA.
Spine Deform. 2021 Jan;9(1):185-190. doi: 10.1007/s43390-020-00176-4. Epub 2020 Aug 11.
Adult spinal deformity (ASD) has increased prevalence in aging populations. Due to the high cost of surgery, studies have evaluated risk factors that predict readmissions and poor outcomes. The American Society of Anesthesiologists (ASA) classification system has been applied to patients with ASD to assess preoperative health and assess the correlation between ASA class and postoperative complications. This study evaluates the relationship between ASA and complications, length of stay (LOS), and direct costs following spine deformity surgery.
Patients undergoing spine deformity surgery at a single institution from 2008-2016 were included and stratified based upon ASA status. Primary outcomes included patient demographics, adjusted LOS, and cost of care. Secondary measures compared between cohorts included adverse events, non-home discharge, and readmission rates.
442 patients with ASD were included in this study. Higher ASA class was correlated with greater Elixhauser Comorbidity Index (ECI) scores (p < 0.0001) and older age (p < 0.0001). Univariate analysis showed longer LOS (p < 0.0001) and greater direct costs in patients with higher ASA class (p < 0.0001). Patients in ASA Class III or IV had the greatest incidence of ICU stay when compared to patients without systemic disease (p < 0.0001). Upon multivariable regression analysis, high ASA class was associated with higher rates of non-home discharge (OR 5.0, 95% CI 3.1-8.1). Direct costs were greater for higher ASA class (regression estimate = + $9,666, p = 0.002).
This study demonstrates that ASA class is correlated with a more complicated postoperative hospital course, greater rates of non-home discharge, total direct costs in spine deformity patients.
成人脊柱畸形（ASD）在老龄化人群中的发病率增加。由于手术费用高昂，因此研究评估了可预测再入院和不良结果的风险因素。美国麻醉医师协会（ASA）分类系统已应用于 ASD 患者，以评估术前健康状况，并评估 ASA 分级与术后并发症之间的相关性。本研究评估了 ASA 分级与脊柱畸形手术后并发症、住院时间（LOS）和直接费用之间的关系。
本研究纳入了 2008 年至 2016 年在一家机构接受脊柱畸形手术的患者，并根据 ASA 状态进行分层。主要结果包括患者人口统计学特征、调整后的 LOS 和护理费用。次要措施比较了队列之间的不良事件、非家庭出院和再入院率。
本研究纳入了 442 例 ASD 患者。较高的 ASA 分级与更高的 Elixhauser 合并症指数（ECI）评分（p<0.0001）和年龄较大（p<0.0001）相关。单因素分析显示，ASA 分级较高的患者 LOS 较长（p<0.0001），直接费用较高（p<0.0001）。与无系统性疾病的患者相比，ASA 分级 III 或 IV 级的患者 ICU 入住率最高（p<0.0001）。多变量回归分析显示，高 ASA 分级与非家庭出院率较高相关（OR 5.0，95%CI 3.1-8.1）。较高的 ASA 分级与较高的直接费用相关（回归估计 = + $9666，p=0.002）。
本研究表明，ASA 分级与脊柱畸形患者术后更复杂的住院过程、非家庭出院率较高、总直接费用较高相关。
