Shahrestani Shane, Bakhsheshian Joshua, Chen Xiao T, Ton Andy, Ballatori Alexander M, Strickland Ben A, Robertson Djani M, Buser Zorica, Hah Raymond, Hsieh Patrick C, Liu John C, Wang Jeffrey C
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
Department of Medical Engineering, California Institute of Technology, Pasadena, CA, United States.
EClinicalMedicine. 2021 May 15;36:100889. doi: 10.1016/j.eclinm.2021.100889. eCollection 2021 Jun.
Modifiable risk factors (MRFs) represent patient variables associated with increased complication rates that may be prevented. There exists a paucity of studies that comprehensively analyze MRF subgroups and their independent association with postoperative complications in patients undergoing cervical spine surgery. Therefore, the purpose of this study is to compare outcomes between patients receiving cervical spine surgery with reported MRFs.
Retrospective analysis of the Nationwide Readmissions Database (NRD) from the years 2016 and 2017, a publicly available and purchasable data source, to include adult patients undergoing cervical fusion. MRF cohorts were separated into three categories: substance abuse (alcohol, tobacco/nicotine, opioid abuse); vascular disease (hypertension, dyslipidemia); and dietary factors (malnutrition, obesity). Three-way nearest-neighbor propensity score matching for demographics, hospital, and surgical characteristics was implemented.
We identified 9601 with dietary MRFs (D-MRF), 9654 with substance abuse MRFs (SA-MRF), and 9503 with vascular MRFs (V-MRF). Those with d-MRFs had significantly higher rates of medical complications (9.3%), surgical complications (8.1%), and higher adjusted hospital costs compared to patients with SA-MRFs and V-MRFs. Patients with d-MRFs (16.3%) and V-MRFs (14.0%) were independently non-routinely discharged at a significantly higher rate compared to patients with SA-MRFs (12.6%) (<0.0001 and = 0.0037). However, those with substance abuse had the highest readmission rate and were more commonly readmitted for delayed procedure-related infections.
A large proportion of patients who receive cervical spine surgery have potential MRFs that uniquely influence their postoperative outcomes. A thorough understanding of patient-specific MRF subgroups allows for improved preoperative risk stratification, tailored patient counseling, and postoperative management planning.
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可改变的风险因素（MRFs）是与可能预防的并发症发生率增加相关的患者变量。目前缺乏全面分析MRF亚组及其与颈椎手术患者术后并发症的独立关联的研究。因此，本研究的目的是比较接受颈椎手术且有报告的MRFs的患者之间的结局。
对2016年和2017年全国再入院数据库（NRD）进行回顾性分析，该数据库是一个可公开获取和购买的数据源，纳入接受颈椎融合术的成年患者。MRF队列分为三类：药物滥用（酒精、烟草/尼古丁、阿片类药物滥用）；血管疾病（高血压、血脂异常）；以及饮食因素（营养不良、肥胖）。对人口统计学、医院和手术特征进行了三向最近邻倾向评分匹配。
我们识别出9601例有饮食MRFs（D-MRF）的患者、9654例有药物滥用MRFs（SA-MRF）的患者和9503例有血管MRFs（V-MRF）的患者。与SA-MRF和V-MRF患者相比，有D-MRF的患者发生医疗并发症（9.3%）、手术并发症（8.1%）的比率显著更高，且调整后的住院费用更高。与SA-MRF患者（12.6%）相比，有D-MRF（16.3%）和V-MRF（14.0%）的患者非常规出院的独立发生率显著更高（<0.0001和=0.0037）。然而，有药物滥用的患者再入院率最高，且更常因延迟的手术相关感染而再次入院。
接受颈椎手术的很大一部分患者具有独特影响其术后结局的潜在MRFs。对特定患者的MRF亚组的透彻理解有助于改善术前风险分层、量身定制患者咨询以及术后管理规划。
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