PDF(Pubmed)
Abstract：
UNASSIGNED: Spinal degenerative disease represents a growing burden on our healthcare system, yet little is known about longitudinal trends in access and care. Our goal was to provide an essential portrait of surgical volume trends for degenerative spinal pathologies within Canada.
UNASSIGNED: The Canadian Institute for Health Information (CIHI) database was used to identify all patients receiving surgery for a degenerative spinal condition from 2006 to 2019. Trends in number of interventions, unscheduled vs scheduled hospitalizations, in-hours vs out-of-hours interventions, resource utilization and adverse events were analyzed retrospectively using linear regression models. Confidence intervals were reported in the expected count ratio scale (CR).
UNASSIGNED: A total of 338,629 spinal interventions and 256,360 hospitalizations between 2006 and 2019 were analyzed. The mean and SD of the annual mean age of patients was 55.5 (SD 1.6) for elective hospitalizations and 55.6 (SD 1.6) for emergent hospitalizations. The proportion of female patients was 47.8% (91,789/192,027) for elective hospitalizations and 41.4% (26,633/64,333) for emergent hospitalizations. Elective hospitalizations increased an average of 2.0% per year, with CR = 1.020 (95% CI 1.017-1.023, p < 0.0001) while emergent hospitalizations exhibited more rapid growth with an average 3.4% annually, with CR 1.034 (95% CI 1.027-1.040, p < 0.0001). «In-hours » surgeries increased on average 2.7% per year, with CR 1.027 (95% CI 1.021-1.033, p < 0.0001), while « out-of-hours » surgeries increased 6.1% annually, with CR 1.061 (95% CI 1.051-1.071, p < 0.0001). The resource utilization for unscheduled hospitalizations approximates two and a half times that of scheduled hospitalizations. The proportions of spinal interventions with at least one adverse event increased on average 6.3% per year, with CR 1.063 (95% CI 1.049-1.077, p < 0.0001).
UNASSIGNED: This study provides novel data critical for all providers and stakeholders. The rapid growth of emergent out-of-hours hospitalizations demonstrates that the needs of this growing patient population have far exceeded health-care resource allocations. Future studies will analyze the health-related quality of life implications of this system shift and identify demographic and socioeconomic inequities in access to surgical care.
UNASSIGNED: This work was funded by the Bob and Trish Saunders Spine Research Fund through The VGH and UBC Hospital Foundation. The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.
UNASSIGNED: The Canadian Institute for Health Information (CIHI) database was used to identify all patients receiving surgery for a degenerative spinal condition from 2006 to 2019. Trends in number of interventions, unscheduled vs scheduled hospitalizations, in-hours vs out-of-hours interventions, resource utilization and adverse events were analyzed retrospectively using linear regression models. Confidence intervals were reported in the expected count ratio scale (CR).
UNASSIGNED: A total of 338,629 spinal interventions and 256,360 hospitalizations between 2006 and 2019 were analyzed. The mean and SD of the annual mean age of patients was 55.5 (SD 1.6) for elective hospitalizations and 55.6 (SD 1.6) for emergent hospitalizations. The proportion of female patients was 47.8% (91,789/192,027) for elective hospitalizations and 41.4% (26,633/64,333) for emergent hospitalizations. Elective hospitalizations increased an average of 2.0% per year, with CR = 1.020 (95% CI 1.017-1.023, p < 0.0001) while emergent hospitalizations exhibited more rapid growth with an average 3.4% annually, with CR 1.034 (95% CI 1.027-1.040, p < 0.0001). «In-hours » surgeries increased on average 2.7% per year, with CR 1.027 (95% CI 1.021-1.033, p < 0.0001), while « out-of-hours » surgeries increased 6.1% annually, with CR 1.061 (95% CI 1.051-1.071, p < 0.0001). The resource utilization for unscheduled hospitalizations approximates two and a half times that of scheduled hospitalizations. The proportions of spinal interventions with at least one adverse event increased on average 6.3% per year, with CR 1.063 (95% CI 1.049-1.077, p < 0.0001).
UNASSIGNED: This study provides novel data critical for all providers and stakeholders. The rapid growth of emergent out-of-hours hospitalizations demonstrates that the needs of this growing patient population have far exceeded health-care resource allocations. Future studies will analyze the health-related quality of life implications of this system shift and identify demographic and socioeconomic inequities in access to surgical care.
UNASSIGNED: This work was funded by the Bob and Trish Saunders Spine Research Fund through The VGH and UBC Hospital Foundation. The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.
摘要：
脊柱退行性疾病对我们的医疗保健系统造成了越来越大的负担，然而，人们对获取和护理的纵向趋势知之甚少。我们的目标是提供加拿大退行性脊柱病理的手术量趋势的基本肖像。
■加拿大健康信息研究所（CIHI）数据库用于识别2006年至2019年因退行性脊柱疾病接受手术的所有患者。干预措施数量的趋势，计划外与计划外住院，工作时间与工作时间外干预，使用线性回归模型对资源利用和不良事件进行回顾性分析.置信区间以预期计数比率量表(CR)报告。
■分析了2006年至2019年期间的338,629例脊柱干预和256,360例住院。选择性住院的患者年平均年龄的平均值和SD为55.5（SD1.6），紧急住院的患者年平均年龄为55.6（SD1.6）。择期住院的女性患者比例为47.8％（91,789/192,027），急诊住院的女性患者比例为41.4％（26,633/64,333）。择期住院平均每年增加2.0%,CR=1.020（95％CI1.017-1.023，p<0.0001），而紧急住院率表现出更快的增长，平均每年3.4％，CR1.034（95%CI1.027-1.040，p<0.0001）。"小时内"手术平均每年增加2.7%,CR1.027（95%CI1.021-1.033，p<0.0001），而“非工作时间”手术每年增长6.1%，CR1.061（95%CI1.051-1.071，p<0.0001）。计划外住院的资源利用率约为计划住院的两倍半。至少有一个不良事件的脊柱干预的比例平均每年增加6.3％，CR1.063（95%CI1.049-1.077，p<0.0001）。
■这项研究为所有提供商和利益相关者提供了至关重要的新数据。紧急非工作时间住院的快速增长表明，这一不断增长的患者群体的需求远远超过了医疗保健资源分配。未来的研究将分析这种系统转变对健康相关的生活质量的影响，并确定获得外科护理的人口和社会经济不平等。
■这项工作由Bob和TrishSaunders脊柱研究基金通过VGH和UBC医院基金会资助。研究的资助者在研究设计中没有作用，数据收集，数据分析,数据解释，或者写手稿。
■加拿大健康信息研究所（CIHI）数据库用于识别2006年至2019年因退行性脊柱疾病接受手术的所有患者。干预措施数量的趋势，计划外与计划外住院，工作时间与工作时间外干预，使用线性回归模型对资源利用和不良事件进行回顾性分析.置信区间以预期计数比率量表(CR)报告。
■分析了2006年至2019年期间的338,629例脊柱干预和256,360例住院。选择性住院的患者年平均年龄的平均值和SD为55.5（SD1.6），紧急住院的患者年平均年龄为55.6（SD1.6）。择期住院的女性患者比例为47.8％（91,789/192,027），急诊住院的女性患者比例为41.4％（26,633/64,333）。择期住院平均每年增加2.0%,CR=1.020（95％CI1.017-1.023，p<0.0001），而紧急住院率表现出更快的增长，平均每年3.4％，CR1.034（95%CI1.027-1.040，p<0.0001）。"小时内"手术平均每年增加2.7%,CR1.027（95%CI1.021-1.033，p<0.0001），而“非工作时间”手术每年增长6.1%，CR1.061（95%CI1.051-1.071，p<0.0001）。计划外住院的资源利用率约为计划住院的两倍半。至少有一个不良事件的脊柱干预的比例平均每年增加6.3％，CR1.063（95%CI1.049-1.077，p<0.0001）。
■这项研究为所有提供商和利益相关者提供了至关重要的新数据。紧急非工作时间住院的快速增长表明，这一不断增长的患者群体的需求远远超过了医疗保健资源分配。未来的研究将分析这种系统转变对健康相关的生活质量的影响，并确定获得外科护理的人口和社会经济不平等。
■这项工作由Bob和TrishSaunders脊柱研究基金通过VGH和UBC医院基金会资助。研究的资助者在研究设计中没有作用，数据收集，数据分析,数据解释，或者写手稿。
