PDF(Pubmed)
Abstract：
Background As the population ages, surgical intervention for degenerative spine conditions is increasing, and this causes a commiserate increase in healthcare expenditures associated with these procedures. Little research has been done on the effect of early-week versus later-week surgeries on patient outcomes, cost, and length of stay (LOS) in patients undergoing lumbar fusion surgery. The purpose of this study is to compare LOS, patient outcomes, and hospital costs between patients having surgery early in the week and later in the week. Methods A retrospective review of 771 patients undergoing a one-, two-, or three-level lumbar fusion from December 2020 to December 2023 at a single institution was performed. Demographics, surgical details, postoperative outcomes and cost were compared between patients who had surgery on Monday, Tuesday, and Wednesday, to those having surgery Thursday or Friday. Univariate and multivariate analyses were performed to compare the groups. Results There were no differences in age, sex, BMI, race, American Society of Anesthesiology (ASA) scores, Charlson Comorbidity Index (CCI) scores, number of operative levels or inpatient/outpatient status between early- and late-week surgeries. Postoperatively the only significant difference was cost, late-week surgeries were, on average, $3,697 more expensive than early-week surgeries ($26,506 vs. $22,809; p<0.001). On multivariate analysis late-week surgeries were 2.47 times more likely to have a non-home discharge (OR: 2.47, 95% CI: 1.24 to 4.95; p=0.010) and 2.19 times more likely to have a 30-day readmission (OR: 2.19, 95% CI:1.01 to 4.74; p=0.044) Additionally, late-week surgeries were $2,041.55 (β:2,041.55, 95% CI: 804.72 to 3,278.38; p=0.001) more expensive than early-week surgeries. Conclusions At our institution, patients undergoing one- to three-level lumbar fusion surgery on Thursday or Friday had a higher risk of non-home discharge, 30-day readmission, and incurred higher cost than those having early-week surgery. Further research is needed to elucidate the reasons for these findings and to evaluate interventions aimed at improving outcomes for patients undergoing surgery later in the week.
摘要：
背景随着人口老龄化,退行性脊柱疾病的手术干预正在增加，这导致与这些程序相关的医疗保健支出增加。关于周初手术与周后手术对患者预后的影响的研究很少，成本,腰椎融合手术患者的住院时间（LOS）。这项研究的目的是比较LOS，患者结果,以及在本周初和本周晚些时候进行手术的患者之间的医院费用。方法回顾性分析771例接受1,two-,或从2020年12月至2023年12月在单个机构进行了三级腰椎融合。人口统计,手术细节,比较了周一接受手术的患者的术后结局和费用，周二,星期三,那些周四或周五做手术的人。进行单变量和多变量分析以比较各组。结果两组患者年龄无差异,性别,BMI,种族,美国麻醉学会（ASA）成绩，Charlson合并症指数（CCI）得分，早期和晚期手术之间的手术水平或住院/门诊状态的数量。术后唯一的显著差异是成本，一周后的手术，平均而言,比周初手术贵3,697美元（26,506美元与22,809美元；p<0.001）。在多变量分析中，术后非家庭出院的可能性是2.47倍（OR：2.47，95％CI：1.24至4.95；p=0.010），再入院30天的可能性是2.19倍（OR：2.19，95％CI：1.01至4.74；p=0.044）。周末手术比周初手术贵2,041.55美元(β:2,041.55,95%CI:804.72至3,278.38;p=0.001)。结论在我们的机构，周四或周五接受一到三级腰椎融合手术的患者非家庭出院的风险较高，重新接纳30天,并且产生的费用高于早期手术的费用。需要进一步的研究来阐明这些发现的原因，并评估旨在改善本周晚些时候接受手术的患者预后的干预措施。
