Kia Cameron, Yannopoulos Aris, Gulati Sagar, Cremins Michael, Cote Mark, Moss Isaac
Department of Orthopaedics, University of Connecticut Health Center, Farmington, CT, USA
Department of Orthopaedics, Saint Francis Hospital and Medical Center, Hartford, CT, USA.
Int J Spine Surg. 2022 Jul 14;16(4):727-34. doi: 10.14444/8296.
While national databases provide large datasets that can be used to understand trends over time, their correlation with prospectively collected data from local registries has not been established. The purpose of the study was to compare differences in patient demographics and adverse events for patients undergoing elective posterior spinal fusion (PSF) between a national database and institutional registry.
A retrospective chart review was performed. A total of 14,618 patients (13,678 patients from the National Surgical Quality Improvement Program [NSQIP] database and 940 patients from the institutional registry) who underwent elective 1- to 2-level PSF were included in the study. Preoperative patient demographics and comorbidities of each cohort were compared. In addition, postoperative 30-day complications and readmission were collected. A multivariate analysis was performed to examine for differences in risk factors for 30-day adverse events between the 2 cohorts.
A total of 13,678 patients from the NSQIP database and 940 patients from the institutional cohort were included for analysis. Mean age was similar between patient cohorts (60.8 ± 13.1 vs 58.8 ± 12.9), with NSQIP having significantly more patients over the age of 65 (41.4% vs 33.2%, < 0.001). Overall complication rate was similar between NSQIP (6.8%) and the institutional registry (8.4%). Both found age and female sex to be significant predictors of 30-day adverse events, while obesity, hypertension, and smoking were only found to be predictive in the NSQIP database.
Age and female sex were found to be independent risk factors for 30-day adverse events between both cohorts, while only NSQIP found modifiable comorbidities to be significant predictors. Although large databases allow for trends in quality over time, subtleties in practice variation and data collection methods at the individual institution level need to be considered when generalizing findings, especially as it pertains to modifiable factors.
Quality metrics and risk factors for patient outcomes are often derived from national databases. This study highlights the differences between study results when outcomes are derived from an institutional registry compared to a national database.
虽然国家数据库提供了可用于了解长期趋势的大型数据集，但它们与从地方登记处前瞻性收集的数据之间的相关性尚未确立。本研究的目的是比较国家数据库和机构登记处中接受择期后路脊柱融合术（PSF）患者的人口统计学差异和不良事件。
进行了一项回顾性图表审查。共有14618例接受择期1至2节段PSF的患者纳入研究（13678例来自国家外科质量改进计划[NSQIP]数据库，940例来自机构登记处）。比较了每个队列术前患者的人口统计学和合并症。此外，收集了术后30天的并发症和再入院情况。进行多变量分析以检查两个队列之间30天不良事件危险因素的差异。
共有13678例来自NSQIP数据库的患者和940例来自机构队列的患者纳入分析。患者队列之间的平均年龄相似（60.8±13.1岁对58.8±12.9岁），NSQIP中65岁以上的患者明显更多（41.4%对33.2%，<0.001）。NSQIP（6.8%）和机构登记处（8.4%）的总体并发症发生率相似。两者均发现年龄和女性性别是30天不良事件的重要预测因素，而肥胖、高血压和吸烟仅在NSQIP数据库中被发现具有预测性。
年龄和女性性别被发现是两个队列中30天不良事件的独立危险因素，而只有NSQIP发现可改变的合并症是重要预测因素。尽管大型数据库可以显示质量随时间的趋势，但在推广研究结果时，尤其是涉及可改变因素时，需要考虑个体机构层面实践差异和数据收集方法的细微之处。
患者预后的质量指标和危险因素通常来自国家数据库。本研究强调了与国家数据库相比，从机构登记处得出的研究结果之间的差异。
