Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, USA.
J Clin Neurosci. 2024 Oct;128:110793. doi: 10.1016/j.jocn.2024.110793. Epub 2024 Aug 28.
Prior literature has examined predictors of length of stay (LOS) for lumbar fusion broadly, grouping multiple surgical approaches into one sample. Evaluating minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) specifically can reduce variability introduced by other approaches to effectively identify predictors of LOS. The purpose of this study is to evaluate preoperative predictors of extended LOS in patients undergoing MIS-TLIF.
MIS-TLIF patients were identified from a spine surgeon's database. Preoperative predictors of LOS, including demographics, comorbidity data, spinal pathology, patient-reported back pain, leg pain, physical function, disability, general physical health, mental health, and depressive burden scores were analyzed. Univariate analysis was performed to identify predictors of LOS ≥ 48 and LOS ≥ 72 h, a multivariate analysis confirmed significance. Eight-hundred-one patients were included.
African-American patients were 4.3 times more likely to have a LOS≥48 h compared to Caucasians (p ≤ 0.001). Diagnosis of herniated nucleus pulposus and foraminal stenosis were negative predictors of an LOS ≥ 72 h (p ≤ 0.014, both). Self-identified African American patients were approximately twice as likely to have a LOS ≥ 72 h compared to Caucasians. Preoperative Oswestry Disability Index (ODI) was positively correlated with LOS ≥ 48 h (p = 0.008). Other baseline patient-reported outcomes (PROs) were not predictive of LOS ≥ 48 or 72 h (p > 0.050, all).
Further research should explore why different demographic characteristics may be associated with extended postoperative LOS to target interventions toward potential health disparities. Understanding preoperative risk factors can help target increased healthcare costs and improve patient care through tailored interventions and future research.
先前的文献广泛研究了腰椎融合术住院时间（LOS）的预测因素，将多种手术方法归入一个样本中。具体评估微创经椎间孔腰椎间融合术（MIS-TLIF）可以减少其他方法带来的变异性，从而有效确定 LOS 的预测因素。本研究旨在评估接受 MIS-TLIF 患者的 LOS 延长的术前预测因素。
从一位脊柱外科医生的数据库中确定了接受 MIS-TLIF 的患者。对 LOS 的术前预测因素进行了分析，包括人口统计学、合并症数据、脊柱病理、患者报告的腰背疼痛、腿部疼痛、身体功能、残疾、一般身体健康、心理健康和抑郁负担评分。进行单变量分析以确定 LOS≥48 小时和 LOS≥72 小时的预测因素，多变量分析确认了其显著性。共纳入 801 例患者。
与白人相比，非裔美国人患者 LOS≥48 小时的可能性高出 4.3 倍（p≤0.001）。椎间盘突出症和侧隐窝狭窄的诊断是 LOS≥72 小时的负预测因素（p≤0.014，均）。自认为是非裔美国人的患者比白人患者 LOS≥72 小时的可能性大约高出两倍。术前 Oswestry 功能障碍指数（ODI）与 LOS≥48 小时呈正相关（p=0.008）。其他基线患者报告结局（PROs）均不能预测 LOS≥48 小时或 72 小时（p>0.050，均）。
进一步的研究应探讨为什么不同的人口统计学特征可能与延长术后 LOS 有关，以针对潜在的健康差异进行干预。了解术前的危险因素可以帮助针对增加的医疗成本，并通过量身定制的干预措施和未来的研究来改善患者护理。
