Rajpal Sharad, Shah Mancy, Vivek Niketna, Burneikiene Sigita
Neurosurgery, Boulder Neurosurgical and Spine Associates, Boulder, USA.
Medicine, University of Colorado Boulder, Boulder, USA.
Cureus. 2020 Aug 28;12(8):e10099. doi: 10.7759/cureus.10099.
Introduction Many clinical, social, and even economic factors have been extensively analyzed in the literature and shown to influence the length of stay (LOS) after spinal procedures. However, surgeon's experience was mostly examined relative to a learning curve and not regarding the time in practice. The primary objective of this study was to determine the effect of one surgeon's experience on the LOS in patients undergoing one- to two-level transforaminal lumbar interbody fusions (TLIFs). Materials and Methods The study design was a retrospective cohort study of hospital discharge data. The cohort was comprised of 240 consecutive patients who had undergone open one- or two-level elective TLIF procedures for lumbar degenerative disc disease. The primary predictor was the surgeon's experience based upon the years of practice. The primary outcome was LOS, which was controlled by the discharge criteria that remained consistent throughout the study. Results Based on the Poisson regression model, it can be inferred that the LOS is not significantly associated with a surgeon's experience (Pr(>|t|) = 0.8985, CI: -0.5825 to 0.5114) while controlling for all other variables. Other independent factors did seem to significantly influence patients' LOS, including the admission type (Pr(>|t|) = 9.637, CI: -0.8186 to -0.3786), the number of TLIF levels (Pr(>|t|) = 1.721, CI: 0.0606 to 0.1446), the Clavien-Dindo ( Pr(>|t|) = 0, CI: 0.1489 to 0.1494), the American Society of Anesthesiologists (ASA) physical status classification scores (Pr(>|t|) = 4.878, CI: 0.0336 to 0.1880), and being discharged to skilled nursing facility (Pr(>|t|) = 3.44, CI: 0.0127 to 0.3339). Conclusions Based upon the years in practice, surgeon experience was not associated with length of hospitalization and estimated blood loss during surgery in patients undergoing one- and two-level TLIF surgeries. However, while controlling for all other variables, the surgeon's experience and surgical time had a highly significant correlation. The study results clearly demonstrated efficiency, but we did not identify a clear correlation between LOS and surgeon experience overtime suggesting that other factors are likely contributing to such outcome. The average LOS is a complex measure of healthcare resource use and hospital discharge policy or other variables are likely having more effect on LOS than individual surgeons' preferences.
引言 在文献中，许多临床、社会甚至经济因素都得到了广泛分析，并显示会影响脊柱手术后的住院时间（LOS）。然而，外科医生的经验大多是相对于学习曲线进行研究的，而非针对实际工作年限。本研究的主要目的是确定一名外科医生的经验对接受一至两节段经椎间孔腰椎椎间融合术（TLIF）患者住院时间的影响。
材料与方法 本研究设计为对医院出院数据的回顾性队列研究。该队列由240例因腰椎间盘退变疾病连续接受开放性一或两节段择期TLIF手术的患者组成。主要预测因素是基于执业年限的外科医生经验。主要结局是住院时间，在整个研究过程中，该指标受保持一致的出院标准控制。
结果 根据泊松回归模型，可以推断在控制所有其他变量时，住院时间与外科医生的经验无显著相关性（Pr(>|t|) = 0.8985，CI：-0.5825至0.5114）。其他独立因素似乎确实对患者的住院时间有显著影响，包括入院类型（Pr(>|t|) = 9.637，CI：-0.8186至-0.3786）、TLIF节段数（Pr(>|t|) = 1.721，CI：0.0606至0.1446）、Clavien-Dindo分级（Pr(>|t|) = 0，CI：0.1489至0.1494）、美国麻醉医师协会（ASA）身体状况分类评分（Pr(>|t|) = 4.878，CI：0.0336至0.1880）以及出院至专业护理机构（Pr(>|t|) = 3.44，CI：0.0127至0.3339）。
结论 基于执业年限，外科医生经验与接受一、两节段TLIF手术患者的住院时间及手术中估计失血量无关。然而，在控制所有其他变量时，外科医生的经验与手术时间具有高度显著的相关性。研究结果清楚地表明了效率，但我们未发现住院时间与外科医生经验随时间的明确相关性，这表明其他因素可能导致了这种结果。平均住院时间是医疗资源使用的一个复杂指标，医院出院政策或其他变量可能比个别外科医生的偏好对住院时间有更大影响。
