Patel Madhav R, Jacob Kevin C, Chavez Frank A, Parsons Alexander W, Seetharaman Meenakshi, Pawlowski Hanna, Prabhu Michael C, Vanjani Nisheka N, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
Int J Spine Surg. 2023 Apr;17(2):205-214. doi: 10.14444/8414. Epub 2022 Dec 13.
Existing literature has not yet evaluated the impact of postoperative length of stay (LOS) on patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) in patients undergoing anterior lumbar interbody fusion (ALIF). The authors investigates the influence of postoperative LOS following ALIF on PROMs and MCID achievement rates.
A single-surgeon database was retrospectively reviewed for patients undergoing single-level ALIF. The following 2 cohorts were studied: patients with LOS <45 hours and patients with LOS ≥45 hours. The following PROMs were recorded at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints: visual analog scale (VAS) back and leg, Oswestry Disability Index (ODI), 12-item short form (SF-12) physical composite score (PCS), and patient-reported outcome measurement information system physical function. MCID achievement was compared by LOS grouping using analysis. The rates of complications by LOS grouping and the relative risk among demographic and perioperative characteristics for a longer hospital stay of ≥45 hours were calculated.
A total of 52 subjects were included in each cohort. LOS ≥45 hours demonstrated worse ODI at 6 weeks and SF-12 PCS preoperative and at 12 weeks ( ≤ 0.026, all). LOS <45 hours demonstrated greater MCID rates for all PROMs except VAS back ( ≤ 0.004, all). Postoperative urinary retention (POUR), fever, and total complications ( ≤ 0.003, all) were associated with increased LOS. Diabetes ( = 0.037), preoperative VAS neck ≥7 ( = 0.012), and American Society of Anesthesiologists classification ≥2 ( = 0.003) served as preoperative risk factors for postoperative stay ≥45 hours.
Following single-level ALIF, patients with shorter LOS demonstrated significantly greater overall MCID achievement for most PROMs. POUR, fever, and total complications were associated with longer LOS and greater blood loss. Diabetes and higher preoperative leg pain were identified as risk factors for longer LOS.
Patients undergoing ALIF with shorter LOS had greater MCID achievement for disability, physical function, and leg pain outcomes. Patients with greater preoperative leg pain and diabetes may be at risk for longer LOS.
现有文献尚未评估腰椎前路椎间融合术（ALIF）患者术后住院时间（LOS）对患者报告结局指标（PROMs）和最小临床重要差异（MCID）的影响。作者调查了ALIF术后LOS对PROMs和MCID达成率的影响。
对接受单节段ALIF手术的患者的单外科医生数据库进行回顾性研究。研究了以下两组队列：LOS＜45小时的患者和LOS≥45小时的患者。在术前以及术后6周、12周、6个月、1年和2年的时间点记录以下PROMs：视觉模拟量表（VAS）背部和腿部评分、Oswestry功能障碍指数（ODI）、12项简短形式（SF-12）身体综合评分（PCS）以及患者报告结局测量信息系统身体功能评分。使用分析方法按LOS分组比较MCID达成情况。计算按LOS分组的并发症发生率以及住院时间≥45小时的患者在人口统计学和围手术期特征方面的相对风险。
每个队列共纳入52名受试者。LOS≥45小时的患者在术后6周时ODI更差，术前及术后12周时SF-12 PCS更差（均P≤0.026）。LOS＜45小时的患者在除VAS背部评分外的所有PROMs方面MCID达成率更高（均P≤0.004）。术后尿潴留（POUR）、发热和总并发症发生率（均P≤0.003）与LOS延长相关。糖尿病（P = 0.037）、术前VAS颈部评分≥7分（P = 0.012）以及美国麻醉医师协会分级≥2级（P = 0.003）是术后住院时间≥45小时的术前危险因素。
在单节段ALIF术后，LOS较短的患者在大多数PROMs方面总体MCID达成情况显著更好。POUR、发热和总并发症与更长的LOS及更多的失血相关。糖尿病和术前腿痛程度较高被确定为LOS延长的危险因素。
接受ALIF手术且LOS较短的患者在残疾、身体功能和腿痛结局方面MCID达成情况更好。术前腿痛程度较高和患有糖尿病的患者可能有LOS延长的风险。
