S L Parker, O Adogwa, T F Witham, O S Aaronson, J Cheng, M J McGirt
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引用次数: 169
Abstract
Introduction: Surgical site infection (SSI) in the setting of lumbar fusion is associated with significant morbidity and medical resource utilization. To date, there have been no studies conducted with sufficient power to directly compare the incidence of SSI following minimally invasive (MIS) vs. open TLIF procedures. Furthermore, studies are lacking that quantify the direct medical cost of SSI following fusion procedures. We set out to determine the incidence of SSI in patients undergoing MIS vs. open TLIF reported in the literature and to determine the direct hospital cost associated with the treatment of SSI following TLIF at our institution.
Methods: A systematic Medline search was performed to identify all published studies assessing SSI after MIS or open TLIF. The cumulative incidence of SSI was calculated from all reported cohorts and compared between MIS vs. open TLIF. In order to determine the direct hospital costs associated with the treatment of SSI following TLIF, we retrospectively reviewed 120 consecutive TLIFs performed at our institution, assessed the incidence of SSI, and calculated the SSI-related hospital costs from accounting and billing records.
Results: To date, there have been 10 MIS-TLIF cohorts (362 patients) and 20 open-TLIF cohorts (1 133 patients) reporting incidences of SSI. The cumulative incidence of reported SSI was significantly lower for MIS vs. open-TLIF (0.6% vs. 4.0%, p=0.0005). In our experience with 120 open TLIF procedures, SSI occurred in 6 (5.0%) patients. The mean hospital cost associated with the treatment of SSI following TLIF was $ 29,110 in these 6 cases. The 3.4% decrease in reported incidence of SSI for MIS vs. open-TLIF corresponds to a direct cost savings of $ 98,974 per 100 MIS-TLIF procedures performed.
Conclusions: Post-operative wound infections following TLIF are costly complications. MIS vs. open TLIF is associated with a decreased reported incidence of SSI in the literature and may be a valuable tool in reducing hospital costs associated with spine care.
导读:腰椎融合术中手术部位感染(SSI)与显著的发病率和医疗资源利用率相关。迄今为止,还没有足够有力的研究直接比较微创(MIS)和开放式TLIF手术后SSI的发生率。此外,缺乏量化融合手术后SSI直接医疗费用的研究。我们着手确定文献中报道的MIS患者与开放式TLIF患者的SSI发生率,并确定我院TLIF后与SSI治疗相关的直接医院费用。方法:进行系统的Medline检索,以确定所有已发表的评估MIS或开放TLIF后SSI的研究。从所有报告的队列中计算SSI的累积发生率,并比较MIS与开放TLIF之间的差异。为了确定与tliff后SSI治疗相关的直接医院费用,我们回顾性地回顾了我院连续实施的120例tliff,评估了SSI的发生率,并从会计和账单记录中计算了SSI相关的医院费用。结果:迄今为止,已有10个MIS-TLIF队列(362例患者)和20个开放式tlif队列(1133例患者)报告了SSI的发生率。报告的SSI累积发生率在MIS组明显低于open-TLIF组(0.6% vs. 4.0%, p=0.0005)。在我们120例开放式TLIF手术的经验中,6例(5.0%)患者发生SSI。在这6例中,与TLIF后SSI治疗相关的平均住院费用为29,110美元。与开放式tlif相比,MIS的SSI发生率降低了3.4%,相当于每进行100例MIS- tlif手术可节省98,974美元的直接成本。结论:TLIF术后伤口感染是代价高昂的并发症。与开放式TLIF相比,MIS与文献中报道的SSI发生率降低有关,可能是降低脊柱护理相关医院费用的有价值工具。