PDF(Pubmed)
Abstract：
UNASSIGNED: Lumbar disc herniation (LDH) is a common condition that can be characterized with disabling pain. While most patients recover without surgery, some still require operative intervention. The epidemiology and trends of laminotomy for LDH have not been recently studied, and current practice patterns might be different from historical norms. This study aimed to investigate the trends of inpatient and outpatient laminotomies for LDH and compare complication rates between these two sites of service.
UNASSIGNED: A large, national database was utilized to identify patients > 8 years old who underwent a laminotomy for LDH between 2009 and 2019. Two cohorts were created based on site of surgery: inpatient versus outpatient. The outpatient cohort was defined as patients who had a length of stay less than 1 day without any associated hospitalization. Epidemiologic analyses for these cohorts were performed by demographics. Patients in both groups were then 1:1 propensity-score matched based on age, sex, insurance type, geographic region, and comorbidities. Ninety-day postoperative complications were compared between cohorts utilizing multivariate logistic regressions.
UNASSIGNED: The average incidence of laminotomy for LDH was 13.0 per 10,000 persons-years. Although the national trend in incidence had not changed from 2009 to 2019, the proportion of outpatient laminotomies significantly increased in this time period (p=.02). Outpatient laminotomies were more common among younger and healthier patients. Patients with inpatient laminotomies had significantly higher rates of surgical site infections (odds ratio [OR] 1.61, p<.001), venous thromboembolism (VTE) (OR 1.96, p<.001), hematoma (OR 1.71, p<.001), urinary tract infections (OR 1.41, p<.001), and acute kidney injuries (OR 1.75, p=.001), even when controlling for selected confounders.
UNASSIGNED: Our study demonstrated an increasing trend in the performance of laminotomy for LDH toward the outpatient setting. Even when controlling for certain confounders, patients requiring inpatient procedures had higher rates of postoperative complications. This study highlights the importance of carefully evaluating the advantages and disadvantages of performing these procedures in an outpatient versus inpatient setting.
UNASSIGNED: A large, national database was utilized to identify patients > 8 years old who underwent a laminotomy for LDH between 2009 and 2019. Two cohorts were created based on site of surgery: inpatient versus outpatient. The outpatient cohort was defined as patients who had a length of stay less than 1 day without any associated hospitalization. Epidemiologic analyses for these cohorts were performed by demographics. Patients in both groups were then 1:1 propensity-score matched based on age, sex, insurance type, geographic region, and comorbidities. Ninety-day postoperative complications were compared between cohorts utilizing multivariate logistic regressions.
UNASSIGNED: The average incidence of laminotomy for LDH was 13.0 per 10,000 persons-years. Although the national trend in incidence had not changed from 2009 to 2019, the proportion of outpatient laminotomies significantly increased in this time period (p=.02). Outpatient laminotomies were more common among younger and healthier patients. Patients with inpatient laminotomies had significantly higher rates of surgical site infections (odds ratio [OR] 1.61, p<.001), venous thromboembolism (VTE) (OR 1.96, p<.001), hematoma (OR 1.71, p<.001), urinary tract infections (OR 1.41, p<.001), and acute kidney injuries (OR 1.75, p=.001), even when controlling for selected confounders.
UNASSIGNED: Our study demonstrated an increasing trend in the performance of laminotomy for LDH toward the outpatient setting. Even when controlling for certain confounders, patients requiring inpatient procedures had higher rates of postoperative complications. This study highlights the importance of carefully evaluating the advantages and disadvantages of performing these procedures in an outpatient versus inpatient setting.
摘要：
■腰椎间盘突出症（LDH）是一种常见病，可表现为致残性疼痛。虽然大多数病人不用手术就能康复,有些仍然需要手术干预。最近尚未研究LDH椎板切开术的流行病学和趋势，当前的实践模式可能与历史规范不同。这项研究旨在调查住院和门诊LDH层切开术的趋势，并比较这两个服务地点之间的并发症发生率。
■一个大的，我们利用国家数据库对2009年至2019年间接受LDH椎板切开术的>8岁患者进行了鉴定.根据手术部位创建了两个队列：住院和门诊。门诊队列定义为住院时间少于1天没有任何相关住院的患者。这些队列的流行病学分析是通过人口统计学进行的。然后，两组患者根据年龄进行1：1的倾向评分匹配，性别,保险类型,地理区域,和合并症。使用多变量逻辑回归比较队列之间的术后90天并发症。
■LDH椎板切开术的平均发生率为13.0/10,000人年。尽管从2009年到2019年，全国发病率趋势没有变化，但在这段时间内，门诊层切开术的比例显着增加（p=0.02）。门诊层切开术在年轻和健康的患者中更为常见。住院患者层切开术的手术部位感染率明显较高（比值比[OR]1.61，p<.001），静脉血栓栓塞（VTE）（OR1.96，p<.001），血肿（OR1.71，p<.001），尿路感染（OR1.41，p<.001），和急性肾损伤（OR1.75，p=.001），即使在控制选定的混杂因素时。
■我们的研究表明，在门诊患者中，LDH的椎板切开术表现有增加的趋势。即使在控制某些混杂因素时，需要住院手术的患者术后并发症发生率较高.这项研究强调了仔细评估在门诊和住院环境中执行这些程序的利弊的重要性。
■一个大的，我们利用国家数据库对2009年至2019年间接受LDH椎板切开术的>8岁患者进行了鉴定.根据手术部位创建了两个队列：住院和门诊。门诊队列定义为住院时间少于1天没有任何相关住院的患者。这些队列的流行病学分析是通过人口统计学进行的。然后，两组患者根据年龄进行1：1的倾向评分匹配，性别,保险类型,地理区域,和合并症。使用多变量逻辑回归比较队列之间的术后90天并发症。
■LDH椎板切开术的平均发生率为13.0/10,000人年。尽管从2009年到2019年，全国发病率趋势没有变化，但在这段时间内，门诊层切开术的比例显着增加（p=0.02）。门诊层切开术在年轻和健康的患者中更为常见。住院患者层切开术的手术部位感染率明显较高（比值比[OR]1.61，p<.001），静脉血栓栓塞（VTE）（OR1.96，p<.001），血肿（OR1.71，p<.001），尿路感染（OR1.41，p<.001），和急性肾损伤（OR1.75，p=.001），即使在控制选定的混杂因素时。
■我们的研究表明，在门诊患者中，LDH的椎板切开术表现有增加的趋势。即使在控制某些混杂因素时，需要住院手术的患者术后并发症发生率较高.这项研究强调了仔细评估在门诊和住院环境中执行这些程序的利弊的重要性。
