Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH.
Spine (Phila Pa 1976). 2021 Mar 15;46(6):401-407. doi: 10.1097/BRS.0000000000003913.
Retrospective observational study.
The aim of this study was to evaluate whether there are any differences in outcomes and costs for elective one- to three-level anterior cervical fusions (ACFs) performed at US News and World Report (USNWR) ranked and unranked hospitals.
Although the USNWR rankings are advertised by media and are routinely used by patients as a guide in seeking care, evidence regarding whether these rankings are reflective of actual clinical outcome remains limited.
The 2010-2014 USNWR hospital rankings were used to identify ranked hospitals in "Neurosurgery" and "Orthopedics." The 2010-2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing elective ACFs at ranked and unranked hospitals. Multivariable logistic regression and generalized linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and unranked hospitals.
A total of 110,520 patients undergoing elective one- to three-level ACFs were included in the study, of which 10,289 (9.3%) underwent surgery in one of the 100 ranked hospitals. Following multivariate analysis, there were no significant differences between ranked versus unranked hospitals with regards to wound complications (1.2% vs. 1.1%; P = 0.907), cardiac complications (12.9% vs. 11.9%; P = 0.055), pulmonary complications (3.7% vs. 6.7%; P = 0.654), urinary tract infections (7.3% vs. 5.8%; P = 0.120), sepsis (9.3% vs. 7.9%; P = 0.847), deep venous thrombosis (1.9% vs. 1.3%; P = 0.077), revision surgery (0.3% vs. 0.3%; P = 0.617), and all-cause readmissions (4.7% vs. 4.4%; P = 0.266). Ranked hospitals, as compared to unranked hospitals, had a slightly lower odds of experiencing renal complications (7.0% vs. 4.9%; P = 0.047), but had significantly higher risk-adjusted 90-day charges (+$17,053; P < 0.001) and costs (+ $1695; P < 0.001).
Despite the higher charges and costs of care at ranked hospitals, these facilities appear to have similar outcomes as compared to unranked hospitals following elective ACFs.Level of Evidence: 3.
回顾性观察性研究。
本研究旨在评估在美国新闻与世界报道（USNWR）排名和未排名的医院进行的择期一至三节段前路颈椎融合术（ACF）的结果和成本是否存在差异。
尽管 USNWR 排名通过媒体宣传，并被患者常规用作寻求治疗的指南，但这些排名是否反映实际临床结果的证据仍然有限。
使用 2010-2014 年 USNWR 医院排名确定“神经外科”和“骨科”中的排名医院。使用 2010-2014 年 100%医疗保险标准分析文件（SAF100）确定在排名和未排名医院接受择期 ACF 的患者。使用多变量逻辑回归和广义线性回归分析评估 90 天结果和排名与未排名医院之间的成本差异。
本研究共纳入 110520 例接受择期一至三节段 ACF 的患者，其中 10289 例（9.3%）在 100 家排名医院之一接受手术。经过多变量分析，排名医院与未排名医院在伤口并发症（1.2%比 1.1%；P=0.907）、心脏并发症（12.9%比 11.9%；P=0.055）、肺部并发症（3.7%比 6.7%；P=0.654）、尿路感染（7.3%比 5.8%；P=0.120）、败血症（9.3%比 7.9%；P=0.847）、深静脉血栓形成（1.9%比 1.3%；P=0.077）、翻修手术（0.3%比 0.3%；P=0.617）和所有原因再入院（4.7%比 4.4%；P=0.266）方面无显著差异。与未排名医院相比，排名医院发生肾脏并发症的几率略低（7.0%比 4.9%；P=0.047），但风险调整后 90 天费用（+$17053；P<0.001）和成本（+$1695；P<0.001）明显更高。
尽管排名医院的护理费用较高，但与未排名医院相比，这些医院在接受择期 ACF 后，结果似乎相似。
3。
