Ratnasamy Philip P, Jabbouri Sahir S, Maloy Gwyneth C, Varthi Arya G, Rubio Daniel R, Grauer Jonathan N
From the Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT.
J Am Acad Orthop Surg Glob Res Rev. 2025 Aug 19;9(8). doi: 10.5435/JAAOSGlobal-D-25-00009. eCollection 2025 Aug 1.
Endoscopic lumbar decompression is growing in popularity as an alternative to an open approach for management of lumbar radiculopathy. Although endoscopic procedures are inherently less invasive, emergency department (ED) visits may occur postoperatively. Although many quality improvement initiatives target readmissions, ED visits may be more common, be a marker of quality of care, affect patient satisfaction, and contribute to healthcare resource utilization and costs.
To characterize the timing and risk factors of ED utilization following single-level endoscopic lumbar decompression.
STUDY DESIGN/SETTING: Retrospective database review.
PearlDiver M165Ortho data set.
Timing of ED utilization following endoscopic lumbar decompression, independent risk factors of ED utilization following endoscopic lumbar decompression, and revision surgery rate among patients who use the ED.
Single-level endoscopic lumbar decompression patients were identified from the PearlDiver M165Ortho data set. Patients were excluded if additional procedures were performed, if they were younger than 18 years, if they had a concomitant diagnosis of trauma, neoplasm, or infection on the day of surgery, or if there was not 90-day follow-up in the data set. Patient factors were extracted, including age, sex, Elixhauser Comorbidity Index, region of the country in which their procedure was performed (Midwest, Northeast, South, West), and patient insurance plan (Commercial, Medicaid, Medicare).The incidence, timing, and frequency of ED utilization within 90 days of endoscopic lumbar decompression was then determined. A baseline rate of weekly ED utilization for the study cohort was calculated based on average weekly ED utilization at 52 to 56 weeks postoperatively. Patient factors predictive of postoperative ED utilization were then determined by univariate and multivariate analyses.
Of 1397 endoscopic lumbar decompression patients identified, 151 (10.8%) visited the ED within 90 days of surgery. Of note, approximately 29% of these ED visits occurred in the first 2 postoperative weeks.Multivariate analysis revealed several independent predictors of ED utilization following endoscopic lumbar decompression, including female sex (odds ratio [OR] 1.57 relative to male), higher Elixhauser Comorbidity Index (OR 1.15 per two-point increase), and Medicaid coverage (OR 2.49 relative to Medicare).Of patients who visited the ED, 97 (64.2%) were readmitted. Less than 11 patients who used the ED underwent revision surgery in the subsequent 2 weeks.
Following endoscopic lumbar decompression, close to 11% of patients were found to visit the ED in the 90 days following their surgery, most commonly in the first two postoperative weeks. Several factors were independently associated with ED utilization, including female sex, greater comorbidity burden, and having Medicaid insurance. Notably, ED utilization rates following endoscopic lumbar decompression are similar to those following open lumbar decompression previously published in the literature. Thus, patients undergoing endoscopic decompression are at similar risk of postoperative ED utilization-surgeons should be aware of this risk and care pathways should be modified to reduce the occurrence of postoperative ED visits in this population.
作为治疗腰椎神经根病的一种替代开放手术的方法，内镜下腰椎减压术越来越受欢迎。虽然内镜手术本质上侵入性较小，但术后可能会出现急诊就诊情况。尽管许多质量改进措施针对再入院，但急诊就诊可能更为常见，是医疗质量的一个指标，影响患者满意度，并导致医疗资源利用和成本增加。
描述单节段内镜下腰椎减压术后急诊利用的时间和危险因素。
研究设计/设置：回顾性数据库分析。
PearlDiver M165Ortho数据集。
内镜下腰椎减压术后急诊利用的时间、内镜下腰椎减压术后急诊利用的独立危险因素以及使用急诊的患者中的翻修手术率。
从PearlDiver M165Ortho数据集中识别出单节段内镜下腰椎减压患者。如果患者接受了额外手术、年龄小于18岁、手术当天伴有创伤、肿瘤或感染诊断，或者数据集中没有90天的随访，则将其排除。提取患者因素，包括年龄、性别、埃利克斯豪泽合并症指数、手术所在国家地区（中西部、东北部、南部、西部）以及患者保险计划（商业保险、医疗补助、医疗保险）。然后确定内镜下腰椎减压术后90天内急诊利用的发生率、时间和频率。根据术后52至56周的平均每周急诊利用率计算研究队列的每周急诊利用基线率。然后通过单因素和多因素分析确定术后急诊利用的预测患者因素。
在1397例内镜下腰椎减压患者中，151例（10.8%）在术后90天内就诊于急诊。值得注意的是，这些急诊就诊中约29%发生在术后前两周。多因素分析显示了内镜下腰椎减压术后急诊利用的几个独立预测因素，包括女性（相对于男性的优势比[OR]为1.57）、较高的埃利克斯豪泽合并症指数（每增加两点OR为1.15）以及医疗补助覆盖（相对于医疗保险的OR为2.49）。在就诊于急诊的患者中，97例（64.2%）被再次入院。在随后2周内，使用急诊的患者中接受翻修手术的不到11例。
内镜下腰椎减压术后，发现近11%的患者在术后90天内就诊于急诊，最常见于术后前两周。几个因素与急诊利用独立相关，包括女性、更大的合并症负担以及拥有医疗补助保险。值得注意的是，内镜下腰椎减压术后的急诊利用率与先前文献中报道的开放腰椎减压术后的利用率相似。因此，接受内镜减压的患者术后急诊利用风险相似——外科医生应意识到这种风险，并且应修改护理途径以减少该人群术后急诊就诊的发生。
