Abstract：
Cervical spondylotic myelopathy (CSM) is a common clinical degenerative disease treated with anterior cervical discectomy and fusion (ACDF), which seriously impacts quality of life and causes severe disability. The objective of the study was to determine the effect of different characteristics of the neurological deficit found in myelopathic patients undergoing ACDFs on hospital cost, length of stay (LOS), and discharge location.
This is a retrospective review of ACDF cases performed at a single institution by multiple surgeons from 2011 to 2017. Patient symptomatology, complications, comorbidities, demographics, surgical time, LOS, and discharge location were collected. Patients with readmissions or reoperations were excluded. Symptoms evaluated were based on clinical diagnosis, Japanese Orthopaedic Association classification, Ranawat grade, and Cooper scales. Symptoms were further grouped using principal component analysis. Cost was defined as surgical episode hospital stay costs plus outpatient clinic costs plus discharge disposition cost. Multivariate linear regression models were created to evaluate correlations with outcomes. The primary outcome was total 90-day hospital costs. Secondary outcomes were discharge location and LOS.
A total of 250 patients were included in the analyses. Discharge location, neuromonitoring use, number of surgical vertebral levels, cage use, LOS, surgical time, having a complication, and sex were all found to be predictive of total 90-day costs. Myelopathic symptomatology was not found to be associated with increased 90-day costs (p ≥ 0.131) when correcting for these other factors. Lower-extremity functionality was found to be associated with increased LOS (p < 0.0001). Upper-extremity myelopathy was found to be associated with increased discharge location needs (p < 0.0001).
Cervical myelopathy was not found to be predictive of total 90-day costs using symptomatology based on multiple myelopathy grading systems. Lower-extremity functionality was, however, found to predict LOS, while upper-extremity myelopathy was found to predict increased discharge location needs. This implies that preoperative deficits from myelopathy should not be considered in a bundled payment system; however, certain myelopathic symptoms should be considered when determining the cost of care.
This is a retrospective review of ACDF cases performed at a single institution by multiple surgeons from 2011 to 2017. Patient symptomatology, complications, comorbidities, demographics, surgical time, LOS, and discharge location were collected. Patients with readmissions or reoperations were excluded. Symptoms evaluated were based on clinical diagnosis, Japanese Orthopaedic Association classification, Ranawat grade, and Cooper scales. Symptoms were further grouped using principal component analysis. Cost was defined as surgical episode hospital stay costs plus outpatient clinic costs plus discharge disposition cost. Multivariate linear regression models were created to evaluate correlations with outcomes. The primary outcome was total 90-day hospital costs. Secondary outcomes were discharge location and LOS.
A total of 250 patients were included in the analyses. Discharge location, neuromonitoring use, number of surgical vertebral levels, cage use, LOS, surgical time, having a complication, and sex were all found to be predictive of total 90-day costs. Myelopathic symptomatology was not found to be associated with increased 90-day costs (p ≥ 0.131) when correcting for these other factors. Lower-extremity functionality was found to be associated with increased LOS (p < 0.0001). Upper-extremity myelopathy was found to be associated with increased discharge location needs (p < 0.0001).
Cervical myelopathy was not found to be predictive of total 90-day costs using symptomatology based on multiple myelopathy grading systems. Lower-extremity functionality was, however, found to predict LOS, while upper-extremity myelopathy was found to predict increased discharge location needs. This implies that preoperative deficits from myelopathy should not be considered in a bundled payment system; however, certain myelopathic symptoms should be considered when determining the cost of care.
摘要：
目的：脊髓型颈椎病（CSM）是临床常见的颈椎前路椎间盘切除融合术（ACDF）治疗的退行性疾病，严重影响生活质量并导致严重残疾。该研究的目的是确定在接受ACDFs的脊髓病患者中发现的不同神经功能缺损特征对住院费用的影响，停留时间(LOS)和排放位置。
方法：这是2011年至2017年由多个外科医生在单个机构进行的ACDF病例的回顾性回顾。患者症状学，并发症,合并症,人口统计，手术时间,LOS,并收集了放电位置。再次入院或再次手术的患者被排除在外。症状评估基于临床诊断，日本骨科协会分类，Ranawat等级,和库珀秤。使用主成分分析进一步对症状进行分组。费用定义为手术发作住院费用加上门诊费用加上出院处置费用。建立多元线性回归模型以评估与结果的相关性。主要结果是90天的总住院费用。次要结果是出院位置和LOS。
结果：共250例患者纳入分析。排放位置,神经监测使用，手术椎骨水平的数量，笼子使用,LOS,手术时间,有并发症，和性别都可以预测90天的总费用。当校正这些其他因素时，未发现脊髓病变症状与90天费用增加有关（p≥0.131）。发现下肢功能与LOS增加相关(p<0.0001)。发现上肢脊髓病与出院位置需求增加相关(p<0.0001)。
结论：使用基于多种脊髓病分级系统的症状学，未发现脊髓型颈椎病可预测90天的总费用。下肢功能是，然而,被发现预测LOS，而发现上肢脊髓病可以预测出院位置需求的增加。这意味着在捆绑支付系统中不应该考虑脊髓病的术前缺陷；但是，在确定护理费用时，应考虑某些脊髓病变症状。
方法：这是2011年至2017年由多个外科医生在单个机构进行的ACDF病例的回顾性回顾。患者症状学，并发症,合并症,人口统计，手术时间,LOS,并收集了放电位置。再次入院或再次手术的患者被排除在外。症状评估基于临床诊断，日本骨科协会分类，Ranawat等级,和库珀秤。使用主成分分析进一步对症状进行分组。费用定义为手术发作住院费用加上门诊费用加上出院处置费用。建立多元线性回归模型以评估与结果的相关性。主要结果是90天的总住院费用。次要结果是出院位置和LOS。
结果：共250例患者纳入分析。排放位置,神经监测使用，手术椎骨水平的数量，笼子使用,LOS,手术时间,有并发症，和性别都可以预测90天的总费用。当校正这些其他因素时，未发现脊髓病变症状与90天费用增加有关（p≥0.131）。发现下肢功能与LOS增加相关(p<0.0001)。发现上肢脊髓病与出院位置需求增加相关(p<0.0001)。
结论：使用基于多种脊髓病分级系统的症状学，未发现脊髓型颈椎病可预测90天的总费用。下肢功能是，然而,被发现预测LOS，而发现上肢脊髓病可以预测出院位置需求的增加。这意味着在捆绑支付系统中不应该考虑脊髓病的术前缺陷；但是，在确定护理费用时，应考虑某些脊髓病变症状。
