Case Western Reserve University School of Medicine, Cleveland, OH.
Center for Spine Health, Cleveland Clinic, Cleveland, OH.
Spine (Phila Pa 1976). 2021 Dec 15;46(24):E1334-E1342. doi: 10.1097/BRS.0000000000004109.
Secondary analysis of a national all-payer database.
Our objectives were to identify patient- and hospital-level factors independently associated with the receipt of nonelective surgery and determine whether nonelective surgery portends differences in perioperative outcomes compared to elective surgery for spinal metastases.
Spinal metastases may progress to symptomatic epidural spinal cord compression that warrants urgent surgical intervention. Although nonelective surgery for spinal metastases has been associated with poor postoperative outcomes, literature evaluating disparities in the receipt of nonelective versus elective surgery in this population is lacking.
The National Inpatient Sample (2012-2015) was queried for patients who underwent surgical intervention for spinal metastases. Multivariable logistic regression models were constructed to evaluate the association of patient- and hospital-level factors with the receipt of nonelective surgery, as well as to evaluate the influence of admission status on perioperative outcomes.
After adjusting for disease-related factors and other baseline covariates, our multivariable logistic regression model revealed several sociodemographic differences in the receipt of nonelective surgery. Patients of black (odds ratio [OR] = 1.38, 95% confidence interval [CI]: 1.03-1.84, P = 0.032) and other race (OR = 1.50, 95% CI: 1.13-1.98, P = 0.005) had greater odds of undergoing nonelective surgery than their white counterparts. Patients of lower income (OR = 1.40, 95% CI: 1.06-1.84, P = 0.019) and public insurance status (OR = 1.56, 95% CI: 1.26-1.93, P < 0.001) were more likely to receive nonelective surgery than higher income and privately insured patients, respectively. Higher comorbidity burden was also associated with greater odds of non-elective admission (OR = 2.94, 95% CI: 2.07-4.16, P < 0.001). With respect to perioperative outcomes, multivariable analysis revealed that patients receiving nonelective surgery were more likely to experience nonroutine discharge (OR = 2.50, 95% CI: 2.09-2.98, P < 0.001) and extended length of stay [LOS] (OR = 2.45, 95% CI: 1.91-3.16, P < 0.001).
The present study demonstrates substantial disparities in the receipt of nonelective surgery across sociodemographic groups and highlights its association with nonroutine discharge and extended LOS.Level of Evidence: 3.
全国所有支付方数据库的二次分析。
我们的目的是确定与接受非择期手术相关的患者和医院水平因素，并确定与脊柱转移瘤的择期手术相比，非择期手术是否预示着围手术期结局的差异。
脊柱转移瘤可能进展为需要紧急手术干预的症状性硬膜外脊髓压迫。尽管非择期手术治疗脊柱转移瘤与术后不良结局相关，但文献中缺乏评估该人群中接受非择期与择期手术差异的研究。
对 2012 年至 2015 年接受脊柱转移瘤手术干预的患者进行国家住院患者样本（National Inpatient Sample，NIS）查询。构建多变量逻辑回归模型，以评估患者和医院水平因素与接受非择期手术的相关性，以及评估入院状态对围手术期结局的影响。
在调整了与疾病相关的因素和其他基线协变量后，我们的多变量逻辑回归模型揭示了在接受非择期手术方面存在几个社会人口统计学差异。与白人患者相比，黑人（比值比 [OR] = 1.38，95%置信区间 [CI]：1.03-1.84，P = 0.032）和其他种族（OR = 1.50，95%CI：1.13-1.98，P = 0.005）的患者接受非择期手术的可能性更大。收入较低（OR = 1.40，95%CI：1.06-1.84，P = 0.019）和公共保险状态（OR = 1.56，95%CI：1.26-1.93，P < 0.001）的患者比收入较高和私人保险的患者更有可能接受非择期手术。更高的合并症负担也与非择期入院的可能性更大相关（OR = 2.94，95%CI：2.07-4.16，P < 0.001）。关于围手术期结局，多变量分析显示，接受非择期手术的患者更有可能经历非常规出院（OR = 2.50，95%CI：2.09-2.98，P < 0.001）和延长的住院时间[LOS]（OR = 2.45，95%CI：1.91-3.16，P < 0.001）。
本研究表明，社会人口统计学群体在接受非择期手术方面存在显著差异，并强调其与非常规出院和延长 LOS 相关。
3 级。
