Song Junho, Katz Austen D, Qureshi Sheeraz A, Virk Sohrab S, Sarwahi Vishal, Silber Jeff, Essig David
Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
J Spine Surg. 2023 Mar 30;9(1):73-82. doi: 10.21037/jss-22-45. Epub 2023 Feb 6.
The coronavirus disease 2019 (COVID-19) pandemic has altered the standard of care for spine surgery in many ways. However, there is a lack of literature evaluating the potential changes in surgical outcomes and perioperative factors for spine procedures performed during the pandemic. In particular, no large database study evaluating the impact of the COVID-19 pandemic on spine surgery outcomes has yet been published. Therefore, the aim of this study was to evaluate the impact of the COVID-19 pandemic on perioperative factors and postoperative outcomes of lumbar fusion procedures.
This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, which was queried for all adult patients who underwent primary lumbar fusion in 2019 and 2020. Patients were grouped into cohorts based on 2019 (pre-pandemic) or 2020 (intra-pandemic) operation year. Differences in 30-day readmission, reoperation, and morbidity rates were evaluated using multivariate logistic regression. Differences in total relative value units (RVUs), RVUs per minute, and total operation time were evaluated using quantile (median) regression. Odds ratios (OR) for length of stay were estimated via negative binomial regression.
A total of 27,446 patients were included in the analysis (12,473 cases in 2020). Unadjusted comparisons of outcomes revealed that lumbar fusions performed in 2020 were associated with higher rates of morbidity, pneumonia, bleeding transfusions, deep venous thrombosis (DVT), and sepsis. 2020 operation year was also associated with longer length of hospital stay, less frequent non-home discharge, higher total RVUs, and higher RVUs per minute. After adjusting for baseline differences in regression analyses, the differences in bleeding transfusions, length of stay, and RVUs per minute were no longer statistically significant. However, operation year 2020 independently predicted morbidity, pneumonia, DVT, and sepsis. In terms of perioperative variables, operation year 2020 predicted greater operative time, non-home discharge, and total RVUs.
Lumbar fusion procedures performed amidst the COVID-19 pandemic were associated with poorer outcomes, including higher rates of morbidity, pneumonia, DVT, and sepsis. In addition, surgeries performed in 2020 were associated with longer operative times and less frequent non-home discharge disposition.
2019年冠状病毒病（COVID-19）大流行在许多方面改变了脊柱手术的护理标准。然而，缺乏文献评估大流行期间脊柱手术的手术结果和围手术期因素的潜在变化。特别是，尚未发表评估COVID-19大流行对脊柱手术结果影响的大型数据库研究。因此，本研究的目的是评估COVID-19大流行对腰椎融合手术围手术期因素和术后结果的影响。
这项回顾性队列研究利用了美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，该数据库查询了2019年和2020年接受初次腰椎融合手术的所有成年患者。根据手术年份将患者分为2019年（大流行前）或2020年（大流行期间）队列。使用多因素逻辑回归评估30天再入院、再次手术和发病率的差异。使用分位数（中位数）回归评估总相对价值单位（RVU）、每分钟RVU和总手术时间的差异。通过负二项回归估计住院时间的比值比（OR）。
共有27446例患者纳入分析（2020年12473例）。未调整的结果比较显示，2020年进行的腰椎融合手术与更高的发病率、肺炎、输血、深静脉血栓形成（DVT）和败血症发生率相关。2020年手术年份还与更长的住院时间、更少的非家庭出院、更高的总RVU和更高的每分钟RVU相关。在回归分析中调整基线差异后，输血、住院时间和每分钟RVU的差异不再具有统计学意义。然而，2020年手术年份独立预测发病率、肺炎、DVT和败血症。在围手术期变量方面，2020年手术年份预测手术时间更长、非家庭出院和总RVU更高。
在COVID-19大流行期间进行的腰椎融合手术与较差的结果相关，包括更高的发病率、肺炎、DVT和败血症发生率。此外，2020年进行的手术与更长的手术时间和更少的非家庭出院处置相关。
