Khan Asham, Meyers Joshua E, Blasio Paul, Mao Jennifer Z, O'Connor Timothy E, Agyei Justice O, Winograd Evan K, Snyder Kenneth V, Mullin Jeffrey P, Levy Elad I, Pollina John
Department of Neurosurgery.
Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health.
Spine (Phila Pa 1976). 2021 May 15;46(10):671-677. doi: 10.1097/BRS.0000000000003896.
Retrospective review.
Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure that may be complicated by airway compromise postoperatively. This life-threatening complication may necessitate reintubation and reoperation. We evaluated the cost utility of conventional postoperative x-ray.
Studies have demonstrated minimal benefit in obtaining an x-ray on postoperative day 1, but there is some utility of postanesthesia care unit (PACU) x-rays for predicting the likelihood of reoperation.
We retrospectively reviewed the records of consecutive patients who underwent ACDF between September 2013 and February 2017. Patients were dichotomized into those who received PACU x-rays and those who did not (control group). Primary outcomes were reoperation, reintubation, mortality, and health care costs.
Eight-hundred and fifteen patients were included in our analysis: 558 had PACU x-rays; 257 did not. In those who received PACU x-rays, mean age was 53.7 ± 11.3 years, mean levels operated on were 2.0 ± 0.79, and mean body mass index (BMI) was 30.3 ± 6.9. In those who did not, mean age was 51.8 ± 10.9 years, mean levels operated on were 1.48 ± 0.65, and mean BMI was 29.9 ± 6.3. Complications in the PACU x-ray group were reintubation-0.4%, reoperation-0.7%, and death-0.3% (due to prevertebral swelling causing airway compromise). Complications in the control group were reintubation-0.4%, reoperation-0.8%, and death-0. There were no differences between groups with respect to reoperation (P = 0.92), reintubation (P = 0.94), or mortality (P = 0.49). The mean per-patient cost was significantly higher (P = 0.009) in those who received PACU x-rays, $1031.76 ± 948.67, versus those in the control group, $700.26 ± 634.48. Mean length of stay was significantly longer in those who had PACU x-rays (P = 0.01).
Although there were no differences in reoperation, reintubation, or mortality, there was a significantly higher cost for care and hospitalization in those who received PACU x-rays. Further studies are warranted to validate the results of the presented study.Level of Evidence: 3.
回顾性研究。
颈椎前路椎间盘切除融合术（ACDF）是一种常见的手术，术后可能并发气道受压。这种危及生命的并发症可能需要再次插管和再次手术。我们评估了术后常规X线检查的成本效益。
研究表明，术后第1天进行X线检查益处极小，但麻醉后监护病房（PACU）的X线检查对预测再次手术的可能性有一定作用。
我们回顾性分析了2013年9月至2017年2月期间连续接受ACDF手术的患者记录。患者被分为接受PACU X线检查的患者和未接受检查的患者（对照组）。主要结局指标为再次手术、再次插管、死亡率和医疗费用。
我们的分析纳入了815例患者：558例接受了PACU X线检查；257例未接受。接受PACU X线检查的患者，平均年龄为53.7±11.3岁，平均手术节段为2.0±0.79个，平均体重指数（BMI）为30.3±6.9。未接受检查的患者，平均年龄为51.8±10.9岁，平均手术节段为1.48±0.65个，平均BMI为29.9±6.3。PACU X线检查组的并发症包括再次插管0.4%、再次手术0.7%、死亡0.3%（由于椎体前肿胀导致气道受压）。对照组的并发症包括再次插管0.4%、再次手术0.8%、死亡0%。两组在再次手术（P = 0.92）、再次插管（P = 0.94）或死亡率（P = 0.49）方面无差异。接受PACU X线检查的患者平均每人费用显著更高（P = 0.009），为1031.76±948.67美元，而对照组为700.26±634.48美元。接受PACU X线检查的患者平均住院时间显著更长（P = 0.01）。
虽然在再次手术、再次插管或死亡率方面没有差异，但接受PACU X线检查的患者护理和住院费用显著更高。需要进一步研究来验证本研究结果。证据级别：3级。
