Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
World Neurosurg. 2024 Aug;188:e18-e24. doi: 10.1016/j.wneu.2024.04.052. Epub 2024 Apr 15.
Dural tears (DTs) are a frequent complication after lumbar spine surgery. We sought to determine the incidence of DTs and the related impact on health care expenditures after lumbar discectomies.
In this retrospective cohort study, all patients with first-time single-level lumbar discectomies at our institution who underwent minimally invasive surgery from 2015 to 2019 were reviewed. Age, sex, weight, height, body mass index, costs, revenues, length of stay, American Society of Anesthesiologists score, Charlson Comorbidity Index, and operative time (OT) were assessed. Exclusion criteria were age <18 years, previous spine surgery, multiple or traumatic disc herniations, and malignant and infectious diseases.
The follow-up time was at least 12 months postoperatively. Of 358 patients identified with lumbar discectomies, 230 met the inclusion criteria. Incidence of DTs was 3.5%. Mean costs (P < 0.001), economic loss (P < 0.01), and OT (P < 0.0001) were found to be significantly higher in the DT group compared with the control group of patients without a DT. The revenues were not statistically different between the 2 groups (P > 0.05). Further analysis of the control group by profit and loss revealed significantly higher body mass index (P < 0.05), length of stay (P < 0.0001), and OT (P < 0.0001) in the loss group.
DTs represent a significant socioeconomic burden in lumbar spine surgery and cause severe secondary complications. The impact of DTs on health care expenses is primarily based on significantly higher OT and a higher mean length of stay.
硬脊膜撕裂（DTs）是腰椎手术后的常见并发症。我们旨在确定腰椎间盘切除术后 DTs 的发生率及其对医疗支出的相关影响。
在这项回顾性队列研究中，我们回顾了我院 2015 年至 2019 年间接受微创手术的首次单节段腰椎间盘切除术的所有患者。评估了年龄、性别、体重、身高、体重指数、费用、收入、住院时间、美国麻醉医师协会评分、Charlson 合并症指数和手术时间（OT）。排除标准为年龄<18 岁、既往脊柱手术、多发或外伤性椎间盘突出症以及恶性和感染性疾病。
术后随访时间至少为 12 个月。在确定的 358 例腰椎间盘切除术患者中，有 230 例符合纳入标准。DTs 的发生率为 3.5%。与无 DTs 的对照组相比，DT 组的平均费用（P<0.001）、经济损失（P<0.01）和 OT（P<0.0001）明显更高。两组的收入无统计学差异（P>0.05）。对对照组的进一步损益分析显示，亏损组的体重指数（P<0.05）、住院时间（P<0.0001）和 OT（P<0.0001）明显更高。
DTs 是腰椎手术中一个重大的社会经济负担，并导致严重的继发性并发症。DTs 对医疗支出的影响主要基于手术时间明显延长和平均住院时间延长。
