Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY.
Clin Spine Surg. 2023 Jun 1;36(5):E198-E205. doi: 10.1097/BSD.0000000000001421. Epub 2023 Jan 19.
This was a retrospective case-control study.
The objective of this study was to evaluate whether prior emergency department admission was associated with an increased risk for 90-day readmission following elective cervical spinal fusion.
The incidence of cervical spine fusion reoperations has increased, necessitating the improvement of patient outcomes following surgery. Currently, there are no studies assessing the impact of emergency department visits before surgery on the risk of 90-day readmission following elective cervical spine surgery. This study aimed to fill this gap and identify a novel risk factor for readmission following elective cervical fusion.
The 2016-2018 Nationwide Readmissions Database was queried for patients aged 18 years and older who underwent an elective cervical fusion. Prior emergency admissions were defined using the variable HCUP_ED in the Nationwide Readmissions Database database. Univariate analysis of patient demographic details, comorbidities, discharge disposition, and perioperative complication was evaluated using a χ 2 test followed by multivariate logistic regression.
In all, 2766 patients fit the inclusion criteria, and 18.62% of patients were readmitted within 90 days. Intraoperative complications, gastrointestinal complications, valvular, uncomplicated hypertension, peripheral vascular disorders, chronic obstructive pulmonary disease, cancer, and experiencing less than 3 Charlson comorbidities were identified as independent predictors of 90-day readmission. Patients with greater than 3 Charlson comorbidities (OR=0.04, 95% CI 0.01-0.12, P <0.001) and neurological complications (OR=0.29, 95% CI 0.10-0.86, P =0.026) had decreased odds for 90-day readmission. Importantly, previous emergency department visits within the calendar year before surgery were a new independent predictor of 90-day readmission (OR=9.74, 95% CI 6.86-13.83, P <0.001).
A positive association exists between emergency department admission history and 90-day readmission following elective cervical fusion. Screening cervical fusion patients for this history and optimizing outcomes in those patients may reduce 90-day readmission rates.
这是一项回顾性病例对照研究。
本研究旨在评估急诊就诊史是否与择期颈椎融合术后 90 天再入院风险增加相关。
颈椎融合术再手术的发生率增加，需要改善术后患者的结局。目前，尚无研究评估手术前急诊就诊对择期颈椎手术后 90 天再入院风险的影响。本研究旨在填补这一空白，并确定颈椎融合术后再入院的新危险因素。
使用全国再入院数据库（Nationwide Readmissions Database）中的 HCUP_ED 变量，检索 2016-2018 年接受择期颈椎融合术的 18 岁及以上患者。使用 χ 2 检验对患者人口统计学特征、合并症、出院去向和围手术期并发症进行单变量分析，然后使用多变量逻辑回归进行评估。
共纳入 2766 例符合纳入标准的患者，其中 18.62%的患者在 90 天内再次入院。术中并发症、胃肠道并发症、瓣膜病、单纯性高血压、周围血管疾病、慢性阻塞性肺疾病、癌症和合并症少于 3 项被确定为 90 天再入院的独立预测因素。合并症大于 3 项（OR=0.04，95%CI 0.01-0.12，P <0.001）和神经并发症（OR=0.29，95%CI 0.10-0.86，P =0.026）的患者 90 天再入院的可能性较低。重要的是，手术前一年内的急诊就诊史是 90 天再入院的新独立预测因素（OR=9.74，95%CI 6.86-13.83，P <0.001）。
急诊就诊史与择期颈椎融合术后 90 天再入院之间存在正相关关系。对颈椎融合术患者进行该病史筛查，并优化这些患者的结局，可能会降低 90 天再入院率。
