Kim Soobin, Ryoo James S, Ostrov Philip B, Reddy Abhinav K, Behbahani Mandana, Mehta Ankit I
12247University of Illinois at Chicago, Chicago, IL, USA.
Global Spine J. 2022 Mar;12(2):278-288. doi: 10.1177/2192568220951137. Epub 2020 Sep 16.
Retrospective cohort study.
To identify disparities in surgical decision making for lumbar disc pathologies based on patient demographics, hospital characteristics, and temporal characteristics of admission.
A retrospective analysis of patients admitted for surgical intervention of disc herniation or degeneration was performed to observe the effect of demographic, hospital, and admission-related factors on the decision to perform an isolated decompression or decompression with single level fusion using the National Inpatient Sample.
Of 84 953 patients with lumbar disc pathologies, 69 975 patients were treated electively, and 14 978 patients were treated nonelectively. Hispanic and Asian/Pacific Islander patients were less likely to receive a fusion for elective cases compared with White patients (odds ratio [OR] 0.88, = .004; OR 0.70, < .001, respectively). In elective cases, privately insured and self-paying patients were less likely to receive a fusion compared with Medicare patients (OR 0.83, < .001; OR 0.66, < .001, respectively), while this effect was limited to self-pay patients in nonelective cases (OR 0.44, < .001). Urban teaching and nonteaching hospitals were less likely to perform fusions compared with rural hospitals in nonelective cases (OR 0.47, < .001; OR 0.58, < .001, respectively). Private for-profit hospitals were associated with higher rates of fusion in both elective and nonelective cases (OR 1.16, = .003; OR 1.94, < .001).
This study illustrates disparities in the modality of surgical intervention for lumbar disc pathologies in terms of demographics, hospital characteristics, and temporal characteristics of admission. The development of more evidence-based guidelines is warranted to reduce variability seen in treatment regimens for these conditions.
回顾性队列研究。
基于患者人口统计学特征、医院特征及入院时间特征，确定腰椎间盘疾病手术决策中的差异。
利用国家住院患者样本，对因椎间盘突出或退变接受手术干预的患者进行回顾性分析，以观察人口统计学、医院及与入院相关的因素对单纯减压或单节段融合减压决策的影响。
在84953例腰椎间盘疾病患者中，69975例接受择期治疗，14978例接受非择期治疗。与白人患者相比，西班牙裔和亚太岛民患者在择期病例中接受融合手术的可能性较小（优势比[OR]分别为0.88，P = 0.004；OR 0.70，P < 0.001）。在择期病例中，与医疗保险患者相比，私人保险和自费患者接受融合手术的可能性较小（OR分别为0.83，P < 0.001；OR 0.66，P < 0.001），而在非择期病例中，这种影响仅限于自费患者（OR 0.44，P < 0.001）。在非择期病例中，城市教学医院和非教学医院与农村医院相比，进行融合手术的可能性较小（OR分别为0.47，P < 0.001；OR 0.58，P < 0.001）。私立营利性医院在择期和非择期病例中融合手术率均较高（OR分别为1.16，P = 0.003；OR 1.94，P < 0.001）。
本研究说明了腰椎间盘疾病手术干预方式在人口统计学、医院特征及入院时间特征方面存在差异。有必要制定更多基于证据的指南，以减少这些疾病治疗方案中的变异性。
