Sam H Jiang, Nauman S Chaudhry, James W Nie, Saavan Patel, Darius Ansari, Jeffrey Z Nie, Pal Shah, Jaimin Patel, Ankit I Mehta
{"title":"择期单层经椎间孔腰椎椎体间融合术后 1 天内出院:对预测因素、并发症和再次入院的倾向评分匹配分析。","authors":"Sam H Jiang, Nauman S Chaudhry, James W Nie, Saavan Patel, Darius Ansari, Jeffrey Z Nie, Pal Shah, Jaimin Patel, Ankit I Mehta","doi":"10.31616/asj.2023.0372","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>This was a retrospective case-control study using 8 years of data from a nationwide database of surgical outcomes in the United States.</p><p><strong>Purpose: </strong>This study aimed to improve our understanding of the risk factors associated with a length of stay (LOS) >1 day and aid in reducing postoperative hospitalization and complications.</p><p><strong>Overview of literature: </strong>Despite the proven safety of transforaminal lumbar interbody fusion (TLIF), some patients face prolonged postoperative hospitalization.</p><p><strong>Methods: </strong>Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2018. The cohort was divided into patients with LOS up to 1 day (LOS ≤1 day), defined as same day or next-morning discharge, and patients with LOS >1 day (LOS >1 day). Univariable and multivariable regression analyses were performed to evaluate predictors of LOS >1 day. Propensity-score matching was performed to compare pre- and postdischarge complication rates.</p><p><strong>Results: </strong>A total of 12,664 eligible patients with TLIF were identified, of which 14.8% had LOS ≤1 day and 85.2% had LOS >1 day. LOS >1 day was positively associated with female sex, Hispanic ethnicity, diagnosis of spondylolisthesis, American Society of Anesthesiologists classification 3, and operation length of >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative/postoperative blood transfusion (0.3% vs. 4.5%, p<0.001) and reoperation (0.1% vs. 0.6%, p=0.004). No significant differences in the rates of postdischarge complications were found between the matched groups.</p><p><strong>Conclusions: </strong>Patients with worsened preoperative status, preoperative diagnosis of spondylolisthesis, and prolonged operative time are more likely to require prolonged hospitalization and blood transfusions and undergo unplanned reoperation. To reduce the risk of prolonged hospitalization and associated complications, patients indicated for TLIF should be carefully selected.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"362-371"},"PeriodicalIF":2.3000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222876/pdf/","citationCount":"0","resultStr":"{\"title\":\"Discharge within 1 day following elective single-level transforaminal lumbar interbody fusion: a propensityscore-matched analysis of predictors, complications, and readmission.\",\"authors\":\"Sam H Jiang, Nauman S Chaudhry, James W Nie, Saavan Patel, Darius Ansari, Jeffrey Z Nie, Pal Shah, Jaimin Patel, Ankit I Mehta\",\"doi\":\"10.31616/asj.2023.0372\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>This was a retrospective case-control study using 8 years of data from a nationwide database of surgical outcomes in the United States.</p><p><strong>Purpose: </strong>This study aimed to improve our understanding of the risk factors associated with a length of stay (LOS) >1 day and aid in reducing postoperative hospitalization and complications.</p><p><strong>Overview of literature: </strong>Despite the proven safety of transforaminal lumbar interbody fusion (TLIF), some patients face prolonged postoperative hospitalization.</p><p><strong>Methods: </strong>Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2018. The cohort was divided into patients with LOS up to 1 day (LOS ≤1 day), defined as same day or next-morning discharge, and patients with LOS >1 day (LOS >1 day). Univariable and multivariable regression analyses were performed to evaluate predictors of LOS >1 day. Propensity-score matching was performed to compare pre- and postdischarge complication rates.</p><p><strong>Results: </strong>A total of 12,664 eligible patients with TLIF were identified, of which 14.8% had LOS ≤1 day and 85.2% had LOS >1 day. LOS >1 day was positively associated with female sex, Hispanic ethnicity, diagnosis of spondylolisthesis, American Society of Anesthesiologists classification 3, and operation length of >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative/postoperative blood transfusion (0.3% vs. 4.5%, p<0.001) and reoperation (0.1% vs. 0.6%, p=0.004). No significant differences in the rates of postdischarge complications were found between the matched groups.</p><p><strong>Conclusions: </strong>Patients with worsened preoperative status, preoperative diagnosis of spondylolisthesis, and prolonged operative time are more likely to require prolonged hospitalization and blood transfusions and undergo unplanned reoperation. To reduce the risk of prolonged hospitalization and associated complications, patients indicated for TLIF should be carefully selected.</p>\",\"PeriodicalId\":8555,\"journal\":{\"name\":\"Asian Spine Journal\",\"volume\":\" \",\"pages\":\"362-371\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222876/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Spine Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.31616/asj.2023.0372\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/5/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Spine Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31616/asj.2023.0372","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/23 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
研究设计:目的:本研究旨在加深我们对住院时间(LOS)大于 1 天的相关风险因素的了解,并帮助减少术后住院和并发症:尽管经椎间孔腰椎椎体间融合术(TLIF)的安全性已得到证实,但仍有部分患者面临术后住院时间过长的问题:数据收集自2011年至2018年的美国外科医生学会国家手术质量改进计划数据集。队列分为住院时间不超过1天(LOS ≤1天)的患者(定义为当日或次日上午出院)和住院时间大于1天(LOS >1天)的患者。为评估LOS >1天的预测因素,进行了单变量和多变量回归分析。为比较出院前和出院后的并发症发生率,进行了倾向分数匹配分析:共确定了12664名符合条件的TLIF患者,其中14.8%的患者LOS≤1天,85.2%的患者LOS>1天。LOS>1天与女性性别、西班牙裔、脊柱滑脱诊断、美国麻醉医师协会分类3以及手术时间>150分钟呈正相关。LOS>1天的患者更有可能术中/术后输血(0.3% vs. 4.5%,P结论:术前状况恶化、术前诊断为脊柱滑脱症、手术时间延长的患者更有可能需要延长住院时间和输血,并接受意外的再次手术。为降低长期住院和相关并发症的风险,应谨慎选择适合接受 TLIF 的患者。
Discharge within 1 day following elective single-level transforaminal lumbar interbody fusion: a propensityscore-matched analysis of predictors, complications, and readmission.
Study design: This was a retrospective case-control study using 8 years of data from a nationwide database of surgical outcomes in the United States.
Purpose: This study aimed to improve our understanding of the risk factors associated with a length of stay (LOS) >1 day and aid in reducing postoperative hospitalization and complications.
Overview of literature: Despite the proven safety of transforaminal lumbar interbody fusion (TLIF), some patients face prolonged postoperative hospitalization.
Methods: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2018. The cohort was divided into patients with LOS up to 1 day (LOS ≤1 day), defined as same day or next-morning discharge, and patients with LOS >1 day (LOS >1 day). Univariable and multivariable regression analyses were performed to evaluate predictors of LOS >1 day. Propensity-score matching was performed to compare pre- and postdischarge complication rates.
Results: A total of 12,664 eligible patients with TLIF were identified, of which 14.8% had LOS ≤1 day and 85.2% had LOS >1 day. LOS >1 day was positively associated with female sex, Hispanic ethnicity, diagnosis of spondylolisthesis, American Society of Anesthesiologists classification 3, and operation length of >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative/postoperative blood transfusion (0.3% vs. 4.5%, p<0.001) and reoperation (0.1% vs. 0.6%, p=0.004). No significant differences in the rates of postdischarge complications were found between the matched groups.
Conclusions: Patients with worsened preoperative status, preoperative diagnosis of spondylolisthesis, and prolonged operative time are more likely to require prolonged hospitalization and blood transfusions and undergo unplanned reoperation. To reduce the risk of prolonged hospitalization and associated complications, patients indicated for TLIF should be carefully selected.