1College of Medicine, University of Florida, Gainesville.
2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville.
Neurosurg Focus. 2023 Sep;55(3):E8. doi: 10.3171/2023.6.FOCUS23288.
Cervical spondylotic myelopathy (CSM) is a common clinical degenerative disease treated with anterior cervical discectomy and fusion (ACDF), which seriously impacts quality of life and causes severe disability. The objective of the study was to determine the effect of different characteristics of the neurological deficit found in myelopathic patients undergoing ACDFs on hospital cost, length of stay (LOS), and discharge location.
This is a retrospective review of ACDF cases performed at a single institution by multiple surgeons from 2011 to 2017. Patient symptomatology, complications, comorbidities, demographics, surgical time, LOS, and discharge location were collected. Patients with readmissions or reoperations were excluded. Symptoms evaluated were based on clinical diagnosis, Japanese Orthopaedic Association classification, Ranawat grade, and Cooper scales. Symptoms were further grouped using principal component analysis. Cost was defined as surgical episode hospital stay costs plus outpatient clinic costs plus discharge disposition cost. Multivariate linear regression models were created to evaluate correlations with outcomes. The primary outcome was total 90-day hospital costs. Secondary outcomes were discharge location and LOS.
A total of 250 patients were included in the analyses. Discharge location, neuromonitoring use, number of surgical vertebral levels, cage use, LOS, surgical time, having a complication, and sex were all found to be predictive of total 90-day costs. Myelopathic symptomatology was not found to be associated with increased 90-day costs (p ≥ 0.131) when correcting for these other factors. Lower-extremity functionality was found to be associated with increased LOS (p < 0.0001). Upper-extremity myelopathy was found to be associated with increased discharge location needs (p < 0.0001).
Cervical myelopathy was not found to be predictive of total 90-day costs using symptomatology based on multiple myelopathy grading systems. Lower-extremity functionality was, however, found to predict LOS, while upper-extremity myelopathy was found to predict increased discharge location needs. This implies that preoperative deficits from myelopathy should not be considered in a bundled payment system; however, certain myelopathic symptoms should be considered when determining the cost of care.
颈椎脊髓病（CSM）是一种常见的临床退行性疾病，采用前路颈椎间盘切除术和融合术（ACDF）进行治疗，严重影响生活质量并导致严重残疾。本研究的目的是确定接受 ACDF 治疗的脊髓病患者的神经功能缺损的不同特征对住院费用、住院时间（LOS）和出院地点的影响。
这是对 2011 年至 2017 年期间在一家机构由多位外科医生进行的 ACDF 病例的回顾性研究。收集了患者的症状、并发症、合并症、人口统计学、手术时间、LOS 和出院地点。排除了再入院或再次手术的患者。评估的症状基于临床诊断、日本矫形协会分类、Ranawat 分级和 Cooper 量表。进一步使用主成分分析对症状进行分组。成本定义为手术住院费用加门诊费用加出院费用。建立多元线性回归模型来评估与结果的相关性。主要结果是总 90 天住院费用。次要结果是出院地点和 LOS。
共有 250 名患者纳入分析。出院地点、神经监测使用、手术椎体数量、椎间融合器使用、LOS、手术时间、并发症和性别均被发现与总 90 天费用相关。在校正这些其他因素后，发现脊髓病症状与增加的 90 天费用无关（p≥0.131）。下肢功能与 LOS 延长有关（p＜0.0001）。上肢脊髓病与增加的出院地点需求有关（p＜0.0001）。
本研究未发现基于多种脊髓病分级系统的症状与总 90 天费用相关。然而，下肢功能被发现可预测 LOS，而上肢脊髓病被发现可预测增加的出院地点需求。这意味着在捆绑支付系统中不应考虑脊髓病的术前缺陷；然而，在确定护理成本时，某些脊髓病症状应被考虑。
