Durand Wesley M, Badin Daniel, Ortiz-Babilonia Carlos, Musharbash Farah N, Raad Micheal, Jain Amit
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
Spine (Phila Pa 1976). 2022 Jul 15;47(14):1011-1017. doi: 10.1097/BRS.0000000000004368. Epub 2022 Jul 1.
A retrospective study.
This study sought to characterize the incidence and timing of postoperative emergency department (ED) visits after common outpatient spinal surgeries performed at ambulatory surgery centers (ASCs) and at hospital outpatient departments (HOPDs).
Outpatient spine surgery has markedly grown in popularity over the past decade. The incidence of ED visits after outpatient spine surgery is not well established.
This study was a retrospective analysis of a large commercial claims insurance database of patients 65 years old and below. Patients who underwent single-level anterior cervical discectomy and fusion, laminectomy, and microdiscectomy were identified. Incidence, timing, and diagnoses associated with ED visits within the postoperative global period (90 d) after surgery were assessed.
In total, 202,202 patients received outpatient spine surgery (19.1% in ASC vs. 80.9% in HOPD). Collectively, there were 22,198 ED visits during the 90-day postoperative period. Approximately 9.0% of patients had at least 1 ED visit, and the incidence varied by procedure: anterior cervical discectomy and fusion 9.9%, laminectomy 9.5%, and microdiscectomy 8.5% ( P <0.0001). After adjusting for age, sex, and comorbidity index, the odds of at least 1 ED visit were higher among patients who received surgery at HOPD versus ASC for all 3 procedures. The majority (56.1%) ED visits occurred during the first month postoperatively; 30.8% (n=6841) occurred within the first week postoperatively, and 10.7% (n=2370) occurred on the same day as the surgery. Postoperative pain was the most common reason for ED visits.
Among commercially insured patients who received outpatient spine surgery, the incidence of ED visits during the 90-day postoperative period was ~9%. Our results indicate opportunities for improved postoperative care planning after outpatient spinal surgery.
一项回顾性研究。
本研究旨在描述在门诊手术中心（ASC）和医院门诊部（HOPD）进行常见门诊脊柱手术后急诊室（ED）就诊的发生率和时间。
在过去十年中，门诊脊柱手术的受欢迎程度显著提高。门诊脊柱手术后急诊室就诊的发生率尚未明确。
本研究是对一个大型商业理赔保险数据库中65岁及以下患者的回顾性分析。确定接受单节段颈椎前路椎间盘切除融合术、椎板切除术和显微椎间盘切除术的患者。评估术后90天内急诊室就诊的发生率、时间和相关诊断。
共有202,202例患者接受了门诊脊柱手术（ASC占19.1%，HOPD占80.9%）。在术后90天内，共有22,198次急诊室就诊。约9.0%的患者至少有1次急诊室就诊，发生率因手术方式而异：颈椎前路椎间盘切除融合术为9.9%，椎板切除术为9.5%，显微椎间盘切除术为8.5%（P<0.0001）。在调整年龄、性别和合并症指数后，所有3种手术中，在HOPD接受手术的患者至少有1次急诊室就诊的几率高于在ASC接受手术的患者。大多数（56.1%）急诊室就诊发生在术后第一个月内；30.8%（n=6841）发生在术后第一周内，10.7%（n=2370）发生在手术当天。术后疼痛是急诊室就诊最常见的原因。
在接受门诊脊柱手术的商业保险患者中，术后90天内急诊室就诊的发生率约为9%。我们的结果表明门诊脊柱手术后改善术后护理计划存在机会。
