Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
World Neurosurg. 2021 Jul;151:e286-e298. doi: 10.1016/j.wneu.2021.04.015. Epub 2021 Apr 15.
The aim of this study was to compare complication rates, length of stay (LOS), and hospital costs after spine surgery for bony spine tumors and intradural spinal neoplasms.
A retrospective cohort study was performed using the National Inpatient Sample database from 2016 to 2017. All adult inpatients who underwent surgical intervention for a primary intradural spinal tumor or primary/metastatic bony spine tumor were identified using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis/procedural coding systems. Patient demographics, comorbidities, intraoperative variables, complications, LOS, discharge disposition, and total cost of hospitalization were assessed. Backward stepwise multivariable logistic regression analyses were used to identify independent predictors of perioperative complication, extended LOS (≥75th percentile), and increased cost (≥75th percentile).
A total of 9855 adult patients were included in the study; 3850 (39.1%) were identified as having a primary intradural spinal tumor and 6005 (60.9%) had a primary or metastatic bony spine tumor. Those treated for bony tumors had more comorbidities (≥3, 67.8% vs. 29.2%) and more commonly experienced ≥1 complications (29.9% vs. 7.9%). Multivariate analyses also showed those in the bony spine cohort had a higher odds of experiencing ≥1 complications (odds ratio [OR], 4.26; 95% confidence interval [CI], 3.04-5.97; P < 0.001), extended LOS (OR, 2.44; 95% CI, 1.75-3.38; P < 0.001), and increased cost (OR, 5.32; 95% CI, 3.67-7.71; P < 0.001).
Relative to patients being treated for primary intradural tumors, those undergoing spine surgery for bony spine tumors experience significantly higher risk for perioperative complications, extended LOS, and increased cost of hospital admission. Further identification of patient and treatment characteristics that may optimize management of spine oncology may reduce adverse outcomes, improve patient care, and reduce health care resources.
本研究旨在比较脊柱肿瘤和椎管内脊髓肿瘤患者接受脊柱手术后的并发症发生率、住院时间（LOS）和住院费用。
使用 2016 年至 2017 年国家住院患者样本数据库进行回顾性队列研究。使用国际疾病分类、第十次修订版临床修正诊断/程序编码系统识别所有接受原发性椎管内脊髓肿瘤或原发性/转移性骨脊柱肿瘤手术干预的成年住院患者。评估患者的人口统计学、合并症、术中变量、并发症、住院时间、出院去向和住院总费用。采用向后逐步多变量逻辑回归分析确定围手术期并发症、延长 LOS（≥75 百分位数）和增加费用（≥75 百分位数）的独立预测因素。
共纳入 9855 名成年患者；3850 名（39.1%）患者被诊断为原发性椎管内脊髓肿瘤，6005 名（60.9%）患者为原发性或转移性骨脊柱肿瘤。接受骨肿瘤治疗的患者合并症更多（≥3 种，67.8%比 29.2%），更常见发生≥1 种并发症（29.9%比 7.9%）。多变量分析还显示，骨脊柱组发生≥1 种并发症的可能性更高（比值比[OR]，4.26；95%置信区间[CI]，3.04-5.97；P<0.001）、延长 LOS（OR，2.44；95%CI，1.75-3.38；P<0.001）和增加住院费用（OR，5.32；95%CI，3.67-7.71；P<0.001）。
与接受原发性椎管内肿瘤治疗的患者相比，接受骨脊柱肿瘤脊柱手术的患者围手术期并发症、延长 LOS 和住院费用增加的风险显著更高。进一步确定可能优化脊柱肿瘤患者管理的患者和治疗特征，可能会降低不良结局，改善患者护理并减少医疗资源的使用。
