Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, 301 East 17th St, New York, NY, USA.
Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, 301 East 17th St, New York, NY, USA.
Spine J. 2021 Sep;21(9):1559-1566. doi: 10.1016/j.spinee.2021.04.020. Epub 2021 May 8.
In 2008, the Centers for Medicare and Medicaid Services (CMS) established a list of hospital-acquired conditions (HACs) with significant deleterious effects on both patients and providers. Adult spinal deformity (ASD) surgery is complex and highly invasive, and as such may result in significant morbidity including these HACs.
Identify predictors for developing the most common HACs among adult spinal deformity (ASD) patients undergoing corrective surgery.
STUDY DESIGN/SETTING: Retrospective analysis.
One thousand one hundred and seventy-one ASD patients.
HACs, Health-Related Quality of Life scores(HRQLs), Reoperation, Integrated Health State (IHS) METHODS: ASD pts undergoing surgery (>18 years, scoliosis ≥20°, SVA ≥5 cm, PT ≥25° and/or TK >60°) with complete data at BL and up to 2 years post-op were included. Patients were stratified by presence of >1 HAC, defined as at least one superficial/deep SSI, UTI, DVT, or PE within a 30-day post-op window. Random forest analysis generated 5,000 Conditional Inference Trees to compute a variable importance table for top predictors of HACs. An area-under-the-curve (AUC) methodology compared normalized HRQL scores between groups to determine an IHS with 2-year follow-up.
Total of 1,171 pts (59.8 years, 76.2%F, 28.1kg/m) underwent corrective ASD surgery, with 1,053 pts in the non-HAC group and 118 in the HAC group. Of these pts, 25.4% had UTI, 15.4% DVT, 19.2% superficial SSI, 20.8% deep SSI, and 19.2% PE. HAC pts were on average older (63.5 vs 59.3, p=.004) and more often frail (51.3 vs 39.7%, p=.021) than non-HAC pts. Postop LOS and reoperation were most associated with HAC groups: [1] LOS >7 days [2] reoperation. Patient-related predictors of HACs were [3] age >50 yerr, [4] frailty, and [13] BMI >31. Procedure-related predictors of HACs were [5] operative-time >405 minutes, [6] levels fused >9, EBL >1450 mL, and [11] decompression. BL radiographic predictors were [7] PT >20°, [9] PI-LL>6°, [10] TL Cobb angle >15°, [12] SVA C7-S1 >29 mm. No differences were observed between groups with regards to IHS ODI (0.73 vs 0.74, p=.863), SRS (1.3 vs1.3, p=.374), NRS Back (0.6 vs 0.6, p=.158). HAC had higher rates of reoperation than non-HAC (0.08 vs 0.01, p=.066), and any HAC within 30-days of index was a significant predictor of reoperation (OR: 2.448 [1.94-3.09], p<.001).
In a population of ASD patients, HACs were associated with length of stay, reoperation, age, and frailty. Radiographic parameters such as pelvic tilt >20°, PI-LL >6°, & SVA >29 mm also increased odds of HACs, and should raise postoperative awareness for HAC development.
2008 年，医疗保险和医疗补助服务中心（CMS）确定了一系列医院获得性疾病（HACs），这些疾病对患者和提供者都有重大的不良影响。成人脊柱畸形（ASD）手术复杂且高度侵入性，因此可能导致包括这些 HACs 在内的重大发病率。
确定接受矫正手术的成人脊柱畸形（ASD）患者发生最常见 HAC 的预测因素。
研究设计/设置：回顾性分析。
1171 名 ASD 患者。
HACs、健康相关生活质量评分（HRQLs）、再手术、综合健康状况（IHS）。
纳入接受手术（>18 岁，脊柱侧凸≥20°，SVA≥5cm，PT≥25°和/或 TK>60°）且 BL 及术后 2 年以上数据完整的 ASD 患者。患者根据是否存在>1 个 HAC 分层，定义为术后 30 天内至少有一个浅表/深部 SSI、UTI、DVT 或 PE。随机森林分析生成了 5000 个条件推断树，以计算 HAC 预测因素的重要性表。通过比较组间归一化 HRQL 评分来评估 AUC 方法，以确定具有 2 年随访的 IHS。
共有 1171 名患者（59.8 岁，76.2%为女性，28.1kg/m）接受了矫正 ASD 手术，其中 1053 名患者在非 HAC 组，118 名患者在 HAC 组。这些患者中，25.4%有 UTI，15.4%DVT，19.2%浅表 SSI，20.8%深部 SSI，19.2%PE。HAC 患者平均年龄较大（63.5 岁比 59.3 岁，p=0.004），且更容易虚弱（51.3%比 39.7%，p=0.021）。术后 LOS 和再手术与 HAC 组最相关：[1] LOS>7 天[2]再手术。HAC 患者的预测因素包括[3]年龄>50 岁，[4]虚弱，和[13]BMI>31。HAC 的程序相关预测因素包括[5]手术时间>405 分钟，[6]融合节段>9，EBL>1450mL，和[11]减压。BL 放射学预测因素包括[7]PT>20°，[9]PI-LL>6°，[10]TL Cobb 角>15°，[12]SVA C7-S1>29mm。在 IHS ODI（0.73 比 0.74，p=0.863）、SRS（1.3 比 1.3，p=0.374）、NRS 背部（0.6 比 0.6，p=0.158）方面，两组间无差异。HAC 再手术率高于非 HAC（0.08 比 0.01，p=0.066），索引后 30 天内任何 HAC 都是再手术的显著预测因素（OR：2.448[1.94-3.09]，p<0.001）。
在 ASD 患者人群中，HACs 与住院时间、再手术、年龄和虚弱有关。骨盆倾斜>20°、PI-LL>6°和 SVA>29mm 等放射学参数也增加了 HACs 的发生几率，术后应提高对 HAC 发展的认识。
Zotero 插件