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:e950-e960. doi: 10.1016/j.wneu.2021.05.022. Epub 2021 May 18.
The prevalence of obesity continues to rise in the United States at a disparaging rate. Although previous studies have attempted to identify the influence obesity has on short-term outcomes following elective spine surgery, few studies have assessed the impact on discharge disposition following anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). The aim of this study was to determine whether obesity impacts the hospital management, cost, and discharge disposition after elective ACDF for adult CSM.
The National Inpatient Sample database was queried using the International Classification of Diseases, 10th revision, Clinical Modification, coding system to identify all (≥18 years) patients with a primary diagnosis of CSM undergoing an elective ACDF for the years 2016 and 2017. Discharge weights were used to estimate national demographics, Elixhauser comorbidities, complications, length of stay, total cost of admission, and discharge disposition.
There were 17,385 patients included in the study, of whom 3035 (17.4%) had obesity (no obesity: 14,350; obesity: 3035). The cohort with obesity had a significantly greater proportion of patients with 3 or more comorbidities compared with the cohort with no obesity (no obesity: 28.1% vs. obesity: 43.5%, P < 0.001). The overall complication rates were greater in the cohort with obesity (no obesity: 10.3% vs. obesity: 14.3%, P = 0.003). On average, the cohort with obesity incurred a total cost of admission $1154 greater than the cost of the cohort with no obesity (no obesity: $19,732 ± 11,605 vs. obesity: $20,886 ± 10,883, P = 0.034) and a significantly greater proportion of nonroutine discharges (no obesity: 16.6% vs. obesity: 24.2%, P < 0.001). In multivariate regression analysis, obesity, age, race, health care coverage, hospital bed size, region, comorbidity, and complication rates all were independently associated with nonroutine discharge disposition.
Our study demonstrates that obesity is an independent predictor for nonroutine discharge disposition following elective anterior cervical discectomy and fusion for cervical spondylotic myelopathy.
在美国，肥胖的患病率持续以令人担忧的速度上升。尽管先前的研究试图确定肥胖对择期脊柱手术后短期结果的影响，但很少有研究评估其对颈椎脊髓病（CSM）前路颈椎间盘切除融合（ACDF）后出院处置的影响。本研究旨在确定肥胖是否会影响成人 CSM 择期 ACDF 后的医院管理、成本和出院处置。
使用国际疾病分类第 10 版临床修订版编码系统，在全国住院患者样本数据库中查询所有（≥18 岁）接受择期 ACDF 治疗的原发性 CSM 患者的资料。使用出院体重估计全国人口统计学、Elixhauser 合并症、并发症、住院时间、入院总成本和出院处置情况。
本研究共纳入 17385 例患者，其中 3035 例（17.4%）患有肥胖症（无肥胖症：14350 例；肥胖症：3035 例）。肥胖组患者的 3 种及以上合并症比例明显高于无肥胖组（无肥胖症：28.1% vs. 肥胖症：43.5%，P<0.001）。肥胖组的总体并发症发生率高于无肥胖组（无肥胖症：10.3% vs. 肥胖症：14.3%，P=0.003）。平均而言，肥胖组的入院总成本比无肥胖组高 1154 美元（无肥胖症：19732±11605 美元 vs. 肥胖症：20886±10883 美元，P=0.034），非常规出院的比例也明显更高（无肥胖症：16.6% vs. 肥胖症：24.2%，P<0.001）。多变量回归分析显示，肥胖、年龄、种族、医疗保健覆盖范围、医院床位大小、地区、合并症和并发症发生率均与非常规出院处置独立相关。
本研究表明，肥胖是颈椎脊髓病前路颈椎间盘切除融合术后非常规出院处置的独立预测因素。
