方法:观察性队列研究。
目的:马尾综合症(CES)是一种罕见的神经系统疾病,具有潜在的破坏性后果。这项研究的目的是比较有和没有CES的患者在后路脊柱减压后2年的术后成本相关治疗。
方法:通过分析商业保险索赔数据库,接受后路脊柱减压并同时诊断为腰椎管狭窄症的患者,神经根病,或2017年的椎间盘突出症被确认并纳入研究.主要结果是手术后2年内确定治疗的费用。治疗包括(1)物理治疗(PT),(2)止痛药,(3)注射,(4)膀胱管理,(5)肠道管理,(6)性功能障碍治疗,(7)心理治疗。
结果:总计,3,140名患者(年龄,55.3±12.0岁;男性,62.2%)被纳入研究。确定的平均治疗总成本为每名患者2,996±6,368美元。非CES患者的确定手术的总费用为2,969±6,356美元,与CES患者的$4,535±6,898相比(P=0.079)。在确定的治疗方法中,CES患者仅PT和膀胱管理费用显着升高(PT:+115%,P<0.001;膀胱管理:+697%,P<0.001)。第一年患者之间的总成本差异显着(非CES:$1,824±3,667;CES:$3,022±4,679;P=0.020)。第二年没有发现差异。
结论:观察到术后第一年发生的费用存在短期差异。除PT和膀胱管理外,患者之间的治疗费用相似。
METHODS: Observational cohort study.
OBJECTIVE: Cauda equina syndrome (CES) is a rare neurologic condition with potentially devastating consequences. The objective of this study was to compare the 2-year postoperative cost-associated treatments after posterior spinal decompression between patients with and without CES.
METHODS: By analyzing a commercial insurance claims database, patients who underwent posterior spinal decompression with a concurrent diagnosis of lumbar spinal stenosis, radiculopathy, or disk herniation in 2017 were identified and included in the study. The primary outcome was the cost of payments for identified treatments in the 2-year period after surgery. Treatments included were (1) physical therapy (PT), (2) pain medication, (3) injections, (4) bladder management, (5) bowel management, (6) sexual dysfunction treatment, and (7) psychological treatment.
RESULTS: In total, 3,140 patients (age, 55.3 ± 12.0 years; male, 62.2%) were included in the study. The average total cost of treatments identified was $2,996 ± 6,368 per patient. The overall cost of identified procedures was $2,969 ± 6,356 in non-CES patients, compared with $4,535 ± 6,898 in patients with CES ( P = 0.079). Among identified treatments, only PT and bladder management costs were significantly higher for patients with CES (PT: +115%, P < 0.001; bladder management: +697%, P < 0.001). The difference in overall cost was significant between patients (non-CES: $1,824 ± 3,667; CES: $3,022 ± 4,679; P = 0.020) in the first year. No difference was found in the second year.
CONCLUSIONS: A short-term difference was observed in costs occurring in the first postoperative year. Cost of treatments was similar between patients apart from PT and bladder management.