Maron Samuel Z, Dan Joshua, Gal Jonathan S, Neifert Sean N, Martini Michael L, Lamb Colin D, Genadry Lisa, Rothrock Robert J, Steinberger Jeremy, Rasouli Jonathan J, Caridi John M
Departments of Neurosurgery.
Anesthesia, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY.
Clin Spine Surg. 2021 Mar 1;34(2):E107-E111. doi: 10.1097/BSD.0000000000001063.
Retrospective analysis of clinical data from a single institution.
The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy.
The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy.
Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates.
Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts.
The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
对来自单一机构的临床数据进行回顾性分析。
本研究的目的是评估手术时间作为显微椎间盘切除术预后、住院时间和费用的可能预测因素。
显微椎间盘切除术的手术量逐年增加，人们对手术结果的关注度也日益提高。先前的研究表明，手术时间与各种手术的临床结果之间存在关联，然而，尚无研究评估其对显微椎间盘切除术的影响。
收集2008年至2016年间所有接受非急诊显微椎间盘切除术患者的人口统计学和预后变量。患者分为两组：下午2点前接受手术的患者被分配到早期组，手术在下午2点后开始的患者被分配到晚期组。使用双变量、多变量逻辑回归和线性回归模型比较预后和患者水平特征。调整后的住院时间和费用是共同主要结局。次要结局包括手术并发症、非回家出院、术后急诊就诊或再入院率。
在符合纳入标准的1261例连续患者中，792例被分配到晚期组，469例被分配到早期组。两组在人口统计学或基线特征方面无显著差异。在未调整分析中，早期组的平均住院时间为1.80（标准差=1.82）天，晚期组为2.00（标准差=1.70）天（P=0.054）。早期队列的平均直接费用为5088美元（标准差=4212美元），晚期队列为4986美元（标准差=2988美元）（P=0.65）。调整后的住院时间或直接费用无差异。两组在手术并发症、非回家出院、术后急诊就诊或再入院率方面未发现统计学显著差异。
研究结果表明，与晚期手术相比，早期手术对显微椎间盘切除术后的手术结果并无显著预测作用。
