Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA,Keck School of Medicine of the University of Southern California, Los Angeles, CA,Department of Medical Engineering, California Institute of Technology, Pasadena, CA,University of California Irvine School of Medicine, Irvine, CA,Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD.
Medicine (Baltimore). 2022 Mar 18;101(11). doi: 10.1097/MD.0000000000029065.
This was a national database study.To examine the role of comorbidities and demographics on inpatient complications in patients with lumbar degenerative conditions.Degenerative conditions of the lumbar spine account for the most common indication for spine surgery in the elderly population in the United States. Significant studies investigating demographic as predictors of surgical rates and health outcomes for degenerative lumbar conditions are lacking.Data were obtained from the National Inpatient Sample from 2010 to 2014 and International Classification of Diseases, 9th revision, Clinical Modification codes were used to identify patients with a primary diagnosis of degenerative lumbar condition. Patients were stratified based on demographic variables and comorbidity status. Multivariate regression analyses were used to determine whether any individual demographic variables, such as race, sex, insurance, and hospital status predicted postoperative complications.A total of 256,859 patients were identified for analysis. The rate of overall complications was found to be 16.1% with a mortality rate of 0.10%. Female, Black, Hispanic, and Asian/Pacific Islander patients had lower odds of receiving surgical treatment compared to White patients (P<.001). Medicare and Medicaid patients were less likely to be surgically managed than patients with private insurance (OR = 0.75, 0.37; P<.001, respectively). Urban hospitals were more likely to provide surgery when compared to rural hospitals (P < .001). Patients undergoing fusion had more complications than decompression alone (P < .001). Females, Medicare insurance status, Medicaid insurance status, urban hospital locations, and certain geographical locations were found to predict postoperative complications (P < .001).There were substantial differences in surgical management and postoperative complications among individuals of different sex, races, and insurance status. Further investigation evaluating the effect of demographics in spine surgery is warranted to fully understand their influence on patient complications.
这是一项全国性数据库研究。旨在探讨合并症和人口统计学因素对腰椎退行性疾病患者住院并发症的影响。腰椎退行性疾病是美国老年人群脊柱手术最常见的指征。尽管有大量研究探讨了人口统计学因素作为预测脊柱退行性疾病手术率和健康结局的指标，但缺乏相关数据。本研究数据来自于 2010 年至 2014 年国家住院患者样本，使用国际疾病分类第 9 版临床修订版代码来确定主要诊断为腰椎退行性疾病的患者。根据人口统计学变量和合并症情况对患者进行分层。采用多变量回归分析来确定任何单一的人口统计学变量（如种族、性别、保险和医院状况）是否可以预测术后并发症。共纳入 256859 例患者进行分析。总体并发症发生率为 16.1%，死亡率为 0.10%。与白人患者相比，女性、黑人、西班牙裔和亚裔/太平洋岛民患者接受手术治疗的可能性较低（P<.001）。与私人保险患者相比，医疗保险和医疗补助患者接受手术治疗的可能性较低（OR=0.75，0.37；P<.001）。与农村医院相比，城市医院更有可能提供手术治疗（P <.001）。与单纯减压相比，融合手术患者的并发症更多（P <.001）。女性、医疗保险状态、医疗补助保险状态、城市医院位置和某些地理位置被发现可以预测术后并发症（P <.001）。不同性别、种族和保险状况的个体之间，手术管理和术后并发症存在显著差异。需要进一步研究评估人口统计学因素在脊柱手术中的作用，以充分了解其对患者并发症的影响。
