Beletsky Alexander, Liu Cherry, Vickery Kim, Hurlock Natalie, Winston Nutan, Loomba Munish, Burton Brittany N, Chitneni Ahish, Gabriel Rodney A, Chen Jeffrey
HCA Healthcare, Department of Anesthesiology, Riverside Community Hospital, Riverside, CA.
HCA Healthcare, Graduate Medical Education, Nashville, TN.
Pain Physician. 2024 Feb;27(2):E285-E291.
Spinal cord stimulator (SCS) surgeries, whether performed using the open or percutaneous approach, are becoming increasingly common for a range of neuropathic pain conditions, including post-laminectomy syndrome and complex regional pain syndrome. However, there is limited knowledge regarding the factors linked to same-day discharge patterns following SCS.
The purpose of this study was to identify factors associated with same-day discharge after SCS placement. The primary outcome was same-day discharge.
Retrospective, cohort study using a nationwide database.
Inclusion criteria included patients who underwent percutaneous or open SCS from January 1, 2014 through December 31, 2021. Exclusion criteria included patients with missing data (n = 178) and those with SCS implants for unlisted indications (n = 1,817). A multivariable analysis was conducted on the outcome data and co-variates associated with same-day discharge after SCS.
After applying inclusion and exclusion criteria, a total of 18,058 patients remained in the final data set, including 7,339 patients who underwent percutaneous SCS and 10,719 patients who underwent open SCS procedures. After analysis, factors associated with increased rates of same-day discharge after SCS included men (odds ratio [OR] 1.16; 95% CI, 1.09 -1.24; P < 0.001), patients on Medicaid (OR 1.64; 95% CI, 0.1.34 - 2.01; P < 0.001), and hospitals in the US Midwest (OR 1.66; 95% CI, 1.45 - 1.90; P < 0.001) and hospitals in the US West (OR 1.32; 95% CI, 1.20 - 1.46; P < 0.001). Factors associated with decreased rates of same-day discharge after SCS included the open approach (OR 0.21; 95% CI, 0.19 - 0.23; P < 0.001), Hispanic ethnicity (OR 0.61; 95% CI, 0.54 - 0.69; P < 0.001) and increased age (OR 0.99; 95% CI, 0.98 - 0.99; P < 0.001).
Since our study is retrospective, the data are subject to various biases, including variable confounding, human error in data entry, and generalizability of the results.
These results can be used to help determine hospital bed needs post-SCS surgery. Future research should focus on identifying the specific reasons certain demographic and geographic factors might influence same-day discharge rates. Our study provides important insights into the factors associated with same-day discharge rates post open and percutaneous SCS implant and highlights the need for patient-centered, evidence-based approaches to health care delivery.
脊髓刺激器（SCS）手术，无论是采用开放手术还是经皮手术方式，在包括椎板切除术后综合征和复杂性区域疼痛综合征在内的一系列神经性疼痛病症的治疗中越来越普遍。然而，关于与SCS术后当日出院模式相关的因素，人们了解有限。
本研究的目的是确定SCS植入术后当日出院的相关因素。主要结局是当日出院。
使用全国性数据库进行的回顾性队列研究。
纳入标准包括2014年1月1日至2021年12月31日期间接受经皮或开放SCS手术的患者。排除标准包括数据缺失的患者（n = 178）和因未列出的适应症而植入SCS的患者（n = 1,817）。对SCS术后当日出院的结局数据和协变量进行多变量分析。
应用纳入和排除标准后，最终数据集中共有18,058例患者，其中7,339例接受了经皮SCS手术，10,719例接受了开放SCS手术。分析后发现，SCS术后当日出院率增加的相关因素包括男性（比值比[OR] 1.16；95%置信区间[CI]，1.09 - 1.24；P < 0.001）、医疗补助计划参保患者（OR 1.64；95% CI，1.34 - 2.01；P < 0.001）、美国中西部地区的医院（OR 1.66；95% CI，1.45 - 1.90；P < 0.001）以及美国西部地区的医院（OR 1.32；95% CI，1.20 - 1.46；P < 0.001）。SCS术后当日出院率降低的相关因素包括开放手术方式（OR 0.21；95% CI，0.19 - 0.23；P < 0.001）、西班牙裔种族（OR 0.61；95% CI，0.54 - 0.69；P < 0.001）和年龄增加（OR 0.99；95% CI，0.98 - 0.99；P < 0.001）。
由于我们的研究是回顾性的，数据存在各种偏差，包括可变混杂因素、数据录入中的人为错误以及结果的可推广性。
这些结果可用于帮助确定SCS手术后的床位需求。未来的研究应侧重于确定某些人口统计学和地理因素可能影响当日出院率的具体原因。我们的研究为开放和经皮SCS植入术后当日出院率的相关因素提供了重要见解，并强调了以患者为中心、基于证据的医疗服务提供方式的必要性。
