Elsamadicy Aladine A, Koo Andrew B, Reeves Benjamin C, Freedman Isaac G, David Wyatt B, Ehresman Jeff, Pennington Zach, Laurans Maxwell, Kolb Luis, Sciubba Daniel M
Department of Neurosurgery, 12228Yale University School of Medicine, New Haven, CT, USA.
Department of Neurosurgery, 1500John Hopkins School of Medicine, Baltimore, MD, USA.
Global Spine J. 2022 Oct;12(8):1792-1803. doi: 10.1177/2192568221989293. Epub 2021 Jan 29.
Retrospective cohort study.
The aim of this study was to determine the impact age has on LOS and discharge disposition following elective ACDF for cervical spondylotic myelopathy (CSM).
A retrospective cohort study was performed using the National Inpatient Sample (NIS) database from 2016 and 2017. All adult patients >50 years old undergoing ACDF for CSM were identified using the ICD-10-CM diagnosis and procedural coding system. Patients were then stratified by age: 50 to 64 years-old, 65 to 79 years-old, and greater than or equal to 80 years-old. Weighted patient demographics, comorbidities, perioperative complications, LOS, discharge disposition, and total cost of admission were assessed.
A total of 14 865 patients were identified. Compared to the 50-64 and 65-79 year-old cohorts, the 80+ years cohort had a significantly higher rate of postoperative complication (50-64 yo:10.2% vs. 65-79 yo:12.6% vs. 80+ yo:18.9%, = 0.048). The 80+ years cohort experienced significantly longer hospital stays (50-64 yo: 2.0 ± 2.4 days vs. 65-79 yo: 2.2 ± 2.8 days vs. 80+ yo: 2.3 ± 2.1 days, = 0.028), higher proportion of patients with extended LOS (50-64 yo:18.3% vs. 65-79 yo:21.9% vs. 80+ yo:28.4%, = 0.009), and increased rates of non-routine discharges (50-64 yo:15.1% vs. 65-79 yo:23.0% vs. 80+ yo:35.8%, < 0.001). On multivariate analysis, age 80+ years was found to be a significant independent predictor of extended LOS [OR:1.97, 95% CI:(1.10,3.55), = 0.023] and non-routine discharge [OR:2.46, 95% CI:(1.44,4.21), = 0.001].
Our study demonstrates that octogenarian age status is a significant independent risk factor for extended LOS and non-routine discharge after elective ACDF for CSM.
回顾性队列研究。
本研究旨在确定年龄对脊髓型颈椎病（CSM）择期前路颈椎间盘切除融合术（ACDF）后的住院时间（LOS）和出院处置的影响。
使用2016年和2017年的国家住院样本（NIS）数据库进行回顾性队列研究。使用ICD - 10 - CM诊断和程序编码系统识别所有年龄大于50岁接受CSM的ACDF成年患者。然后按年龄将患者分层：50至64岁、65至79岁和大于或等于80岁。评估加权后的患者人口统计学、合并症、围手术期并发症、LOS、出院处置和住院总费用。
共识别出14865例患者。与50 - 64岁和65 - 79岁队列相比，80岁及以上队列术后并发症发生率显著更高（50 - 64岁：10.2% 对65 - 79岁：12.6% 对80岁及以上：18.9%，P = 0.048）。年龄80岁及以上队列的住院时间显著更长（50 - 64岁：2.0±2.4天对65 - 79岁：2.2±2.8天对80岁及以上：2.3±2.1天，P = 0.028），住院时间延长的患者比例更高（50 - 64岁：18.3% 对65 - 79岁：21.9% 对80岁及以上：28.4%，P = 0.009），非常规出院率增加（50 - 64岁：15.1% 对65 - 79岁：23.0% 对80岁及以上：35.8%，P < 0.001）。多因素分析显示，80岁及以上年龄是住院时间延长[比值比（OR）：1.97，95%置信区间（CI）：（1.10，3.55），P = 0.023]和非常规出院[OR：2.46，95% CI：（1.44，4.21），P = 0.001]的显著独立预测因素。
我们的研究表明，在CSM择期ACDF后，八旬老人的年龄状况是住院时间延长和非常规出院的显著独立危险因素。
