背景:脊髓刺激器(SCS)手术,无论是使用开放还是经皮入路,在一系列神经性疼痛中变得越来越普遍,包括椎板切除术后综合征和复杂的区域疼痛综合征。然而,关于SCS后当天出院模式相关因素的知识有限。
目的:本研究的目的是确定与SCS放置后当天出院相关的因素。主要结果是当天出院。
方法:回顾性,使用全国数据库进行队列研究。
方法:纳入标准包括2014年1月1日至2021年12月31日接受经皮或开放性SCS的患者。排除标准包括数据缺失的患者(n=178)和未列出适应症的SCS植入物患者(n=1,817)。对结果数据和与SCS后当天出院相关的协变量进行了多变量分析。
结果:应用纳入和排除标准后,共有18058名患者保留在最终数据集中,包括7,339例接受经皮SCS的患者和10,719例接受开放式SCS手术的患者。经过分析,与SCS后当天出院率增加相关的因素包括男性(比值比[OR]1.16;95%CI,1.09-1.24;P<0.001),接受医疗补助的患者(OR1.64;95%CI,0.1.34-2.01;P<0.001),和美国中西部的医院(OR1.66;95%CI,1.45-1.90;P<0.001)和美国西部的医院(OR1.32;95%CI,1.20-1.46;P<0.001)。与SCS后当天出院率降低相关的因素包括开放方法(OR0.21;95%CI,0.19-0.23;P<0.001),西班牙裔种族(OR0.61;95%CI,0.54-0.69;P<0.001)和年龄增加(OR0.99;95%CI,0.98-0.99;P<0.001)。
结论:由于我们的研究是回顾性的,数据受到各种偏见的影响,包括变量混杂,数据输入中的人为错误,和结果的概括性。
结论:这些结果可用于帮助确定SCS手术后医院病床的需求。未来的研究应侧重于确定某些人口和地理因素可能影响当天出院率的具体原因。我们的研究提供了与开放和经皮SCS植入后当天出院率相关的因素的重要见解,并强调了以患者为中心的需求,基于证据的医疗保健服务方法。
BACKGROUND: Spinal cord stimulator (SCS) surgeries, whether performed using the open or percutaneous approach, are becoming increasingly common for a range of neuropathic pain conditions, including post-laminectomy syndrome and complex regional pain syndrome. However, there is limited knowledge regarding the factors linked to same-day discharge patterns following SCS.
OBJECTIVE: The purpose of this study was to identify factors associated with same-day discharge after SCS placement. The primary outcome was same-day discharge.
METHODS: Retrospective, cohort study using a nationwide database.
METHODS: Inclusion criteria included patients who underwent percutaneous or open SCS from January 1, 2014 through December 31, 2021. Exclusion criteria included patients with missing data (n = 178) and those with SCS implants for unlisted indications (n = 1,817). A multivariable analysis was conducted on the outcome data and co-variates associated with same-day discharge after SCS.
RESULTS: After applying inclusion and exclusion criteria, a total of 18,058 patients remained in the final data set, including 7,339 patients who underwent percutaneous SCS and 10,719 patients who underwent open SCS procedures. After analysis, factors associated with increased rates of same-day discharge after SCS included men (odds ratio [OR] 1.16; 95% CI, 1.09 -1.24; P < 0.001), patients on Medicaid (OR 1.64; 95% CI, 0.1.34 - 2.01; P < 0.001), and hospitals in the US Midwest (OR 1.66; 95% CI, 1.45 - 1.90; P < 0.001) and hospitals in the US West (OR 1.32; 95% CI, 1.20 - 1.46; P < 0.001). Factors associated with decreased rates of same-day discharge after SCS included the open approach (OR 0.21; 95% CI, 0.19 - 0.23; P < 0.001), Hispanic ethnicity (OR 0.61; 95% CI, 0.54 - 0.69; P < 0.001) and increased age (OR 0.99; 95% CI, 0.98 - 0.99; P < 0.001).
CONCLUSIONS: Since our study is retrospective, the data are subject to various biases, including variable confounding, human error in data entry, and generalizability of the results.
CONCLUSIONS: These results can be used to help determine hospital bed needs post-SCS surgery. Future research should focus on identifying the specific reasons certain demographic and geographic factors might influence same-day discharge rates. Our study provides important insights into the factors associated with same-day discharge rates post open and percutaneous SCS implant and highlights the need for patient-centered, evidence-based approaches to health care delivery.