■从诊断程序组合(DPC)数据库提取的数据的回顾性研究。
■本研究旨在探讨早期手术的效果。
■颈椎骨折脱位(CFD)的最佳手术时机尚不清楚,因为仅发表了一些大约100名患者的临床研究。
■本研究包括4,653名来自DPC数据库的明确诊断为CFD的成年患者。该数据库包含从日本超过1,000家急性护理医院收集的全国住院数据。DPC数据库包含有关住院的信息,如诊断,治疗,病史,并发症,和住院结果。这项研究在一对一倾向评分匹配(PSM)后确定了460对患者。比较入院后72小时内(早期组)和后期(延迟组)接受CFD手术的患者的治疗结果。主要结果包括30天死亡率,住院死亡,和主要并发症。次要结果是Barthel指数的改善,住院时间,和出院率。
■调整PSM后,早期组的30天死亡率明显高于延迟组(3.0%vs.0.4%,p=0.006)。在PSM后的多变量逻辑回归分析中,早期组与30天死亡率风险增加相关(比值比,8.05;95%置信区间,2.15-5.26;p=0.007)。
■这项研究表明,早期手术的CFD导致30天死亡率增加。
METHODS: Retrospective study of data abstracted from the Diagnosis Procedure Combination (DPC) database.
OBJECTIVE: This study aimed to investigate the effects of surgery in the early phase.
BACKGROUND: The optimal timing of surgery for cervical fracture dislocation (CFD) remains unclear because only a few clinical studies with approximately 100 patients have been published.
METHODS: This study included 4,653 adult patients with a definitive diagnosis of CFD from the DPC database. The database contains nationwide inpatient data collected from >1,000 acute care hospitals in Japan. The DPC database contains information regarding hospitalization, such as diagnosis, treatment, medical history, complications, and hospitalization outcomes. This study identified 460 pairs of patients after one-to-one propensity-score matching (PSM). Treatment outcomes were compared between patients who underwent surgery for CFD within 72 hours (early group) and later (delayed group) after admission. The main outcomes included 30-day mortality, inhospital death, and major complications. The secondary outcomes were improvement in the Barthel index, length of hospital stay, and discharged home rate.
RESULTS: After adjusting for PSM, the early group had a significantly higher 30-day mortality rates than the delayed group (3.0% vs. 0.4%, p=0.006). In the multivariate logistic regression analysis after PSM, the early group was associated with an increased risk of 30-day mortality (odds ratio, 8.05; 95% confidence interval, 2.15-5.26; p=0.007).
CONCLUSIONS: This study indicated that early surgery for CFD resulted in increased 30-day mortality.