Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA; Department of Orthopaedic and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany.
Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA.
World Neurosurg. 2022 Aug;164:e183-e193. doi: 10.1016/j.wneu.2022.04.067. Epub 2022 Apr 25.
The aims of this study were to determine the time trend of demographics, complications, and outcomes for patients undergoing posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF) or anterior lumbar interbody fusion/lateral lumbar interbody fusion (ALIF/LLIF) and to compare the differences in the time trends between both procedures.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing PLIF/TLIF and ALIF/LLIF procedures. Outcomes were analyzed for differences between 2 time periods in the PLIF/TLIF and ALIF/LLIF cohorts separately (2009-2013 and 2015-2019). Longitudinal time trends of the 2 procedures were determined by difference-in-differences (DID) analysis. Statistical significance was defined as P < 0.05.
For both approaches, there was an increase in age and American Society of Anesthesiologists class over time, accompanied by a significant decrease in blood transfusions and morbidity. The DID analysis showed a greater change in age (DID:-1.8%; P < 0.001), and more patients were rated American Society of Anesthesiologists class 3 (DID: -2.4%; P = 0.033) in the ALIF/LLIF cohort than in the PLIF/TLIF cohort. Length of stay declined significantly over time in both cohorts, with a greater reduction observed for patients who underwent ALIF/LLIF than for patients who underwent PLIF/TLIF (DID: 0.2%; P = 0.014). There were no changes in readmission rates over time in either cohort (PLIF/TLIF DID: 0.6%; P = 0.080; ALIF/LLIF DID: -0.2%; P = 0.696).
Time trends for PLIF/TLIF and ALIF/LIIF showed a significant increase in the number of older patients with complex medical status undergoing surgery. Despite these trends, there were decreases in overall postoperative morbidity, incidence of blood transfusion, and length of stay, without increasing readmission. These results suggest general improvement in surgical and perioperative management of lumbar fusion over time with greater gains found in ALIF/LLIF-specific care than in PLIF/TLIF.
本研究旨在确定行后路腰椎间融合/经椎间孔腰椎间融合术（PLIF/TLIF）或前路腰椎间融合/侧路腰椎间融合术（ALIF/LLIF）的患者的人口统计学、并发症和结局的时间趋势，并比较两种手术之间时间趋势的差异。
美国外科医师学会国家手术质量改进计划数据库中检索行 PLIF/TLIF 和 ALIF/LLIF 手术的患者。分别对 PLIF/TLIF 和 ALIF/LLIF 队列的 2 个时间段（2009-2013 年和 2015-2019 年）的结果进行分析。通过差异（DID）分析确定两种手术的纵向时间趋势。定义 P < 0.05 为统计学意义。
对于两种方法，随着时间的推移，年龄和美国麻醉医师协会（ASA）分级均增加，同时输血和发病率显著下降。DID 分析显示年龄变化更大（DID：-1.8%；P < 0.001），在 ALIF/LLIF 队列中，ASA 分级 3 级的患者比例高于 PLIF/TLIF 队列（DID：-2.4%；P = 0.033）。两个队列的住院时间均随时间显著缩短，ALIF/LLIF 组患者的住院时间缩短幅度大于 PLIF/TLIF 组（DID：0.2%；P = 0.014）。两个队列的再入院率均无随时间变化的趋势（PLIF/TLIF DID：0.6%；P = 0.080；ALIF/LLIF DID：-0.2%；P = 0.696）。
PLIF/TLIF 和 ALIF/LLIF 的时间趋势显示，接受手术的年龄较大、合并症较多的患者数量显著增加。尽管存在这些趋势，但总体术后发病率、输血发生率和住院时间均有所下降，再入院率并未增加。这些结果表明，随着时间的推移，腰椎融合手术的外科和围手术期管理普遍得到改善，ALIF/LLIF 特定护理的改善程度大于 PLIF/TLIF。
