Departments of1Neurosurgery and.
2Henry Ford Health System, Detroit, Michigan.
J Neurosurg Spine. 2024 Mar 1;40(6):751-757. doi: 10.3171/2024.1.SPINE23842. Print 2024 Jun 1.
Emergency department visits 90 days after elective spinal surgery are relatively common, with rates ranging from 9% to 29%. Emergency visits are very costly, so their reduction is of importance. This study's objective was to evaluate the reasons for emergency department visits and determine potentially modifiable risk factors.
This study retrospectively reviewed data queried from the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry from July 2020 to November 2021. MSSIC is a multicenter (28-hospital) registry of patients undergoing cervical and lumbar degenerative spinal surgery. Adult patients treated for elective cervical and/or lumbar spine surgery for degenerative pathology (spondylosis, intervertebral disc disease, low-grade spondylolisthesis) were included. Emergency department visits within 90 days of surgery (outcome measure) were analyzed utilizing univariate and multivariate regression analyses.
Of 16,224 patients, 2024 (12.5%) presented to the emergency department during the study period, most commonly for pain related to spinal surgery (31.5%), abdominal problems (15.8%), and pain unrelated to the spinal surgery (12.8%). On multivariate analysis, age (per 5-year increase) (relative risk [RR] 0.94, 95% CI 0.92-0.95), college education (RR 0.82, 95% CI 0.69-0.96), private insurance (RR 0.79, 95% CI 0.70-0.89), and preoperative ambulation status (RR 0.88, 95% CI 0.79-0.97) were associated with decreased emergency visits. Conversely, Black race (RR 1.30, 95% CI 1.13-1.51), current diabetes (RR 1.13, 95% CI 1.01-1.26), history of deep venous thromboembolism (RR 1.28, 95% CI 1.16-1.43), history of depression (RR 1.13, 95% CI 1.03-1.25), history of anxiety (RR 1.32, 95% CI 1.19-1.46), history of osteoporosis (RR 1.21, 95% CI 1.09-1.34), history of chronic obstructive pulmonary disease (RR 1.19, 95% CI 1.06-1.34), American Society of Anesthesiologists class > II (RR 1.18, 95% CI 1.08-1.29), and length of stay > 3 days (RR 1.29, 95% CI 1.16-1.44) were associated with increased emergency visits.
The most common reasons for emergency department visits were surgical pain, abdominal dysfunction, and pain unrelated to index spinal surgery. Increased focus on postoperative pain management and bowel regimen can potentially reduce emergency visits. The risks of diabetes, history of osteoporosis, depression, and anxiety are areas for additional preoperative screening.
择期脊柱手术后 90 天内的急诊就诊相对常见，发生率为 9%至 29%。急诊就诊费用非常高，因此减少急诊就诊非常重要。本研究的目的是评估急诊就诊的原因，并确定潜在的可改变的危险因素。
本研究回顾性分析了 2020 年 7 月至 2021 年 11 月期间从密歇根州脊柱手术改进合作组织（MSSIC）注册中心查询的数据。MSSIC 是一个多中心（28 家医院）的颈椎和腰椎退行性脊柱手术患者登记处。纳入接受颈椎和/或腰椎退行性病变（颈椎病、椎间盘疾病、低度脊椎滑脱）择期脊柱手术治疗的成年患者。利用单变量和多变量回归分析对手术 90 天内的急诊就诊（结局指标）进行分析。
在 16224 名患者中，2024 名（12.5%）在研究期间到急诊就诊，最常见的原因是与脊柱手术相关的疼痛（31.5%）、腹部问题（15.8%）和与脊柱手术无关的疼痛（12.8%）。多变量分析显示，年龄（每增加 5 岁）（相对风险 [RR] 0.94，95%置信区间 [CI] 0.92-0.95）、大学教育（RR 0.82，95% CI 0.69-0.96）、私人保险（RR 0.79，95% CI 0.70-0.89）和术前活动状态（RR 0.88，95% CI 0.79-0.97）与急诊就诊减少相关。相反，黑种人（RR 1.30，95% CI 1.13-1.51）、当前糖尿病（RR 1.13，95% CI 1.01-1.26）、深静脉血栓形成史（RR 1.28，95% CI 1.16-1.43）、抑郁症史（RR 1.13，95% CI 1.03-1.25）、焦虑症史（RR 1.32，95% CI 1.19-1.46）、骨质疏松症史（RR 1.21，95% CI 1.09-1.34）、慢性阻塞性肺疾病史（RR 1.19，95% CI 1.06-1.34）、美国麻醉医师协会（ASA）分级> II 级（RR 1.18，95% CI 1.08-1.29）和住院时间> 3 天（RR 1.29，95% CI 1.16-1.44）与急诊就诊增加相关。
急诊就诊最常见的原因是手术疼痛、腹部功能障碍和与指数脊柱手术无关的疼痛。增加对术后疼痛管理和肠道方案的关注可能会减少急诊就诊。糖尿病、骨质疏松症、抑郁症和焦虑症的风险是额外术前筛查的领域。
