Ciol M A, Deyo R A, Howell E, Kreif S
Department of Health Services, University of Washington, Seattle, USA.
J Am Geriatr Soc. 1996 Mar;44(3):285-90. doi: 10.1111/j.1532-5415.1996.tb00915.x.
To study temporal trends and geographic variations in the use of surgery for spinal stenosis, estimate short-term morbidity and mortality of the procedure, and examine the likelihood of repeat back surgery after surgical repair.
Cohort study based on Medicare claims.
Hospital care.
All Medicare beneficiaries 65 years of age or older who received a lumbar spine operation for spinal stenosis in 1985 or 1989 were followed through 1991 (10,260 patients from the 1985 cohort and 18,655 from the 1989 cohort).
Two outcomes were measured: (1) rates of operation for spinal stenosis by state and (2) on an individual level, operative complications (cardiopulmonary, vascular, or infectious), postoperative mortality, and time between first operation and any subsequent reoperation.
Rates of surgery for spinal stenosis increased eightfold from 1979 to 1992 for patients aged 65 and older and varied almost fivefold among US states. Mortality and operative complications increased with age and comorbidity. Complications were more likely for men and for individuals receiving spinal fusions. The 1989 cohort experienced a slightly higher probability of reoperation than the 1985 cohort for the first 3 years of follow-up.
A rapid increase in surgery rates for spinal stenosis was identified over a 14-year period. The wide geographic variations and substantial complication rate from this elective surgical procedure (partly related to patient age) suggest a need for more information on the relative efficacy of surgical and nonsurgical treatments for this condition. The risks and benefits of particular surgical procedures for specific clinical and demographic subgroups as well as individual patient preferences regarding surgical risks and possible outcomes should also be evaluated further. These issues are likely to become increasingly important with the aging of the US population.
研究脊柱狭窄手术使用情况的时间趋势和地理差异，估计该手术的短期发病率和死亡率，并检查手术修复后再次进行背部手术的可能性。
基于医疗保险索赔的队列研究。
医院护理。
所有1985年或1989年接受腰椎脊柱狭窄手术的65岁及以上医疗保险受益人，随访至1991年（1985年队列中有10260名患者，1989年队列中有18655名患者）。
测量了两个结果：（1）各州脊柱狭窄手术率；（2）在个体层面，手术并发症（心肺、血管或感染性）、术后死亡率以及首次手术与任何后续再次手术之间的时间间隔。
1979年至1992年，65岁及以上患者的脊柱狭窄手术率增长了八倍，美国各州之间的差异几乎为五倍。死亡率和手术并发症随年龄和合并症增加而上升。男性以及接受脊柱融合术的个体发生并发症的可能性更大。在随访的前3年中，1989年队列再次手术的概率略高于1985年队列。
在14年期间，脊柱狭窄手术率迅速上升。这种选择性手术的广泛地理差异和较高的并发症发生率（部分与患者年龄有关）表明，需要更多关于该疾病手术和非手术治疗相对疗效的信息。还应进一步评估特定临床和人口亚组的特定手术程序的风险和益处，以及个体患者对手术风险和可能结果的偏好。随着美国人口老龄化，这些问题可能会变得越来越重要。
