随着美国医疗系统相关费用的不断上涨,正在努力将传统的住院程序转变为门诊当日手术。在这项研究中,作者研究了各种合并症和围手术期并发症及其对门诊与住院患者3级和4级颈前路椎间盘切除术和融合术(ACDF)的再入院率的影响。
这是一项回顾性研究,在2012年5月至2017年6月期间,对332例患者(5例患者同时进行了初级手术和修正手术,共包括337例手术)进行了337个3级和4级ACDF手术。总的来说,分析了331个程序,6例患者失访。门诊手术进行了299个手术(102个4级手术和197个3级手术),进行了32例住院手术(11例4级手术和21例3级手术).年龄,性别,合并症,融合水平的数量,疼痛程度,比较两组患者围手术期并发症。
对6家不同医院的331个3级和4级ACDF程序进行了分析。30天的总再入院率为1.2%(门诊3例[1.0%]vs住院1例[3.1%],p=0.847)。门诊患者再入院风险增加,伴有冠状动脉疾病的合并症(OR1.058,p=0.039),自身免疫性疾病(OR1.142,p=0.006),糖尿病(OR1.056,p=0.001),和慢性肾脏病(OR0.933,p=0.035)。与住院患者相比,围手术期谵妄并发症(OR2.709,p<0.001)和手术部位感染(OR2.709,p<0.001)与门诊患者30天再入院风险增加相关。
这项研究证明了3级和4级ACDF手术的安全性和有效性,尽管各种合并症和围手术期并发症可能导致更高的再入院率。门诊3级和4级ACDF病例的患者选择可能在门诊环境中执行这些程序的安全性中起作用。但是需要进一步的研究来准确地确定哪些因素对于适当的选择最相关。
With the costs related to the United States medical system constantly rising, efforts are being made to turn traditional inpatient procedures into outpatient same-day surgeries. In this study the authors looked at the various comorbidities and perioperative complications and their impact on readmission rates of patients undergoing outpatient versus inpatient 3- and 4-level anterior cervical discectomy and fusion (ACDF).
This was a retrospective study of 337 3- and 4- level ACDF procedures in 332 patients (5 patients had both primary and revision surgeries that were included in this total of 337 procedures) between May 2012 and June 2017. In total, 331 procedures were analyzed, as 6 patients were lost to follow-up. Outpatient surgery was performed for 299 procedures (102 4-level procedures and 197 3-level procedures), and inpatient surgery was performed for 32 procedures (11 4-level procedures and 21 3-level procedures). Age, sex, comorbidities, number of fusion levels, pain level, and perioperative complications were compared between both cohorts.
Analysis was performed for 331 3- and 4-level ACDF procedures done at 6 different hospitals. The overall 30-day readmission rate was 1.2% (outpatient 3 [1.0%] vs inpatient 1 [3.1%], p = 0.847). Outpatients had increased readmission risk, with comorbidities of coronary artery disease (OR 1.058, p = 0.039), autoimmune disease (OR 1.142, p = 0.006), diabetes (OR 1.056, p = 0.001), and chronic kidney disease (OR 0.933, p = 0.035). Perioperative complications of delirium (OR 2.709, p < 0.001) and surgical site infection (OR 2.709, p < 0.001) were associated with increased risk of 30-day hospital readmission in outpatients compared to inpatients.
This study demonstrates the safety and effectiveness of 3- and 4-level ACDF surgery, although various comorbidities and perioperative complications may lead to higher readmission rates. Patient selection for outpatient 3- and 4-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection.