Department of Neurosurgery, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
World Neurosurg. 2022 May;161:e54-e60. doi: 10.1016/j.wneu.2021.11.100. Epub 2021 Nov 29.
Increased posterior cervical decompression and fusion (PCDF) procedures over the past decade have raised the prospect of bundled payment plans. The American Society of Anesthesiologists (ASA) Physical Status Classification system may enable accurate estimation of health care costs, length of stay (LOS), and other postoperative outcomes in patients undergoing PCDF.
Low (I and II) versus high (III and IV) ASA class was used to evaluate 971 patients who underwent PCDF between 2008 and 2016 at a single institution. Demographics were compared using univariate analysis. Cost of care, LOS, and postoperative complications were compared using multivariable logistic and linear regression, controlling for sex, age, length of surgery, and number of segments fused.
The high ASA class cohort was older (mean age 62 years vs. 55 years, P < 0.0001) and had higher Elixhauser comorbidity index scores (P < 0.0001). ASA class was independently associated with longer LOS (2.1 days, 95% confidence interval [CI] 1.3-2.9, P < 0.0001) and higher cost ($2936, 95% CI $1457-$4415, P < 0.0001). Patients with high ASA class were more likely to have a nonhome discharge (3.9, 95% CI 2.8-5.6, P < 0.0001), delayed extubation (3.2, 95% CI 1.4-7.3, P = 0.006), intensive care unit stay (2.4, 95% CI 1.5 3.7, P = 0.0001), in-hospital complications (1.5, 95% CI 1.0-2.2, P = 0.03), and 30-day (3.2, 95% CI 1.5-6.8, P = 0.003) and 90-day (3.2, 95% CI 1.8-5.7, P = 0.0001) readmission.
High ASA class is strongly associated with increased costs, LOS, and adverse outcomes following PCDF and could be useful for preoperative prediction of these outcomes.
过去十年中，颈椎后路减压融合术（PCDF）的数量不断增加，这使得捆绑式支付计划成为可能。美国麻醉医师协会（ASA）体格状况分类系统可能能够准确估计接受 PCDF 的患者的医疗保健成本、住院时间（LOS）和其他术后结果。
低（I 和 II）与高（III 和 IV）ASA 级用于评估 2008 年至 2016 年在一家机构接受 PCDF 的 971 名患者。使用单变量分析比较人口统计学数据。使用多变量逻辑和线性回归比较医疗费用、LOS 和术后并发症，同时控制性别、年龄、手术时间和融合节段数。
高 ASA 级队列年龄较大（平均年龄 62 岁比 55 岁，P < 0.0001），Elixhauser 合并症指数评分较高（P < 0.0001）。ASA 分级与 LOS 延长独立相关（2.1 天，95%置信区间 [CI] 1.3-2.9，P < 0.0001）和医疗费用增加（2936 美元，95%CI 1457-4415 美元，P < 0.0001）。ASA 分级较高的患者更有可能非家庭出院（3.9，95%CI 2.8-5.6，P < 0.0001）、延迟拔管（3.2，95%CI 1.4-7.3，P = 0.006）、入住重症监护病房（2.4，95%CI 1.5-3.7，P = 0.0001）、院内并发症（1.5，95%CI 1.0-2.2，P = 0.03）、30 天（3.2，95%CI 1.5-6.8，P = 0.003）和 90 天（3.2，95%CI 1.8-5.7，P = 0.0001）再入院。
高 ASA 级与 PCDF 后成本增加、LOS 延长和不良结局密切相关，可用于术前预测这些结局。
