门诊前路腰椎椎间融合手术的安全性：一项荟萃分析的系统评价
Safety of Outpatient Anterior Lumbar Interbody Fusion Surgery: A Systematic Review With Meta-Analyses.
作者信息
Weisbrod Luke J, Staple Brandon L, Westmark Danielle M, Gard Andrew P, Surdell Daniel L
机构信息
Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
School of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
出版信息
Int J Spine Surg. 2024 Nov 19;18(6):705-11. doi: 10.14444/8661.
BACKGROUND
Due to rapidly rising health care costs, leveraging outpatient surgery to reduce hospital inpatient burden is being explored. This study provides a systematic review of the literature on outpatient anterior lumbar interbody fusion (ALIF) with pooled analysis to determine its safety and feasibility.
METHODS
Embase (Elsevier), MEDLINE (National Library of Medicine), CINAHL (EBSCO), and the Cochrane Library (Wiley) were searched on 8 April 2024 for articles mentioning the following search concepts: (1) ambulatory; (2) outpatient; and (3) ALIF surgery. Included studies had (1) patients undergoing outpatient ALIF; (2) an inpatient control group; (3) a sample size of ≥5 in each cohort; and (4) a population aged ≥18 years. Outcome data were extracted from studies meeting inclusion criteria, and Newcastle-Ottawa scores were assigned to included studies lacking a prospective, randomized design. Fixed and random effects models were used to establish ORs and mean difference with 95% CIs for each outcome.
RESULTS
Pooled analysis included results from 4 studies. A total of 2070 patients underwent outpatient ALIF and 12,554 underwent inpatient ALIF. The results showed that compared with inpatient ALIF, outpatient ALIF resulted in a statistically significant decrease in postoperative adverse events (OR -0.89, 95% CI [-1.69, -0.09], = 54.88%, = 0.03), comparable readmission rates (OR 0.02, 95% CI [-0.16, 0.20], = 0%, = 0.816), and nearly statistically significant decrease in reoperation rates (OR -0.41, 95% CI [-0.83, -0.00], = 0%, = 0.05).
DISCUSSION
These meta-analyses suggest that outpatient ALIF is associated with a statistically significant decrease in postoperative adverse events without a significant difference in hospital readmission or reoperation rates. These results suggest that in carefully selected patients, outpatient ALIF is safe and feasible. This study is limited by pooled analysis of retrospective data.
CLINICAL RELEVANCE
This systematic review contributes to the assessment of the safety of outpatient ALIF spine surgery.
背景
由于医疗保健成本迅速上升，人们正在探索利用门诊手术来减轻医院住院负担。本研究对门诊前路腰椎椎间融合术（ALIF）的文献进行了系统综述，并进行汇总分析以确定其安全性和可行性。
方法
于2024年4月8日在Embase（爱思唯尔）、MEDLINE（国立医学图书馆）、CINAHL（EBSCO）和Cochrane图书馆（威利）中检索提及以下检索概念的文章：（1）门诊的；（2）门诊病人；（3）ALIF手术。纳入的研究需满足：（1）患者接受门诊ALIF手术；（2）有住院对照组；（3）每个队列样本量≥5；（4）人群年龄≥18岁。从符合纳入标准的研究中提取结局数据，并为缺乏前瞻性随机设计的纳入研究分配纽卡斯尔-渥太华评分。使用固定效应模型和随机效应模型来确定每个结局的OR值和95%CI的平均差。
结果
汇总分析纳入了4项研究的结果。共有2070例患者接受了门诊ALIF手术，12554例接受了住院ALIF手术。结果显示，与住院ALIF手术相比，门诊ALIF手术术后不良事件在统计学上显著减少（OR -0.89，95%CI[-1.69，-0.09]，I² = 54.88%，P = 0.03），再入院率相当（OR 0.02，95%CI[-0.16，0.20]，I² = 0%，P = 0.816），再次手术率近乎在统计学上显著降低（OR -0.41，95%CI[-0.83，-0.00]，I² = 0%，P = 0.05）。
讨论
这些荟萃分析表明，门诊ALIF手术与术后不良事件在统计学上显著减少相关，而医院再入院率或再次手术率无显著差异。这些结果表明，在精心挑选的患者中，门诊ALIF手术是安全可行的。本研究受回顾性数据汇总分析的限制。
临床意义
本系统综述有助于评估门诊ALIF脊柱手术的安全性。
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