{"title":"计算机辅助导航并不能改善青少年特发性脊柱侧凸后路融合术的疗效。","authors":"Aaron Singh, Travis Kotzur, Blaire Peterson, Ezekial Koslosky, Chimobi Emukah, Christopher Chaput","doi":"10.1177/21925682241274373","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>The aim of this study was to compare the efficacy of CT-based computer assisted navigation (CAN) to conventional pedicle screw placement for patients with Adolescent Idiopathic Scoliosis (AIS).</p><p><strong>Methods: </strong>This retrospective cohort study drew data from the National Readmissions Database, years 2016-2019. Patients undergoing posterior fusion for AIS, either via CAN or fluoroscopic-guided procedures, were identified via ICD-10 codes. Multivariate regression was performed to compare outcomes between operative techniques. Negative binomial regression was used to asses discharge disposition, while Gamma regression was performed to assess length of stay (LOS) and total charges. Patient demographics and comorbidities, measured via the Elixhauser comorbidity index, were both controlled for in our regression analysis.</p><p><strong>Results: </strong>28,868 patients, 2095 (7.3%) undergoing a CAN procedure, were included in our analysis. Patients undergoing CAN procedures had increased surgical complications (Odds Ratio (OR) 2.23; <i>P</i> < 0.001), namely, blood transfusions (OR 2.47; <i>P</i> < 0.001). Discharge disposition and LOS were similar, as were reoperation and readmission rates; however, total charges were significantly greater in the CAN group (OR 1.37; <i>P</i> < 0.001). Mean charges were 191,489.42 (119,302.30) USD for conventional surgery vs 268 589.86 (105,636.78) USD for the CAN cohort.</p><p><strong>Conclusion: </strong>CAN in posterior fusion for AIS does not appear to decrease postoperative complications and is associated with an increased need for blood transfusions. Given the much higher total cost of care that was also seen with CAN, this study calls into question whether the use of CAN is justified in this setting.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Computer Assisted Navigation Does Not Improve Outcomes in Posterior Fusion for Adolescent Idiopathic Scoliosis.\",\"authors\":\"Aaron Singh, Travis Kotzur, Blaire Peterson, Ezekial Koslosky, Chimobi Emukah, Christopher Chaput\",\"doi\":\"10.1177/21925682241274373\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objective: </strong>The aim of this study was to compare the efficacy of CT-based computer assisted navigation (CAN) to conventional pedicle screw placement for patients with Adolescent Idiopathic Scoliosis (AIS).</p><p><strong>Methods: </strong>This retrospective cohort study drew data from the National Readmissions Database, years 2016-2019. Patients undergoing posterior fusion for AIS, either via CAN or fluoroscopic-guided procedures, were identified via ICD-10 codes. Multivariate regression was performed to compare outcomes between operative techniques. Negative binomial regression was used to asses discharge disposition, while Gamma regression was performed to assess length of stay (LOS) and total charges. Patient demographics and comorbidities, measured via the Elixhauser comorbidity index, were both controlled for in our regression analysis.</p><p><strong>Results: </strong>28,868 patients, 2095 (7.3%) undergoing a CAN procedure, were included in our analysis. Patients undergoing CAN procedures had increased surgical complications (Odds Ratio (OR) 2.23; <i>P</i> < 0.001), namely, blood transfusions (OR 2.47; <i>P</i> < 0.001). Discharge disposition and LOS were similar, as were reoperation and readmission rates; however, total charges were significantly greater in the CAN group (OR 1.37; <i>P</i> < 0.001). Mean charges were 191,489.42 (119,302.30) USD for conventional surgery vs 268 589.86 (105,636.78) USD for the CAN cohort.</p><p><strong>Conclusion: </strong>CAN in posterior fusion for AIS does not appear to decrease postoperative complications and is associated with an increased need for blood transfusions. Given the much higher total cost of care that was also seen with CAN, this study calls into question whether the use of CAN is justified in this setting.</p>\",\"PeriodicalId\":12680,\"journal\":{\"name\":\"Global Spine Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-08-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Global Spine Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/21925682241274373\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Global Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/21925682241274373","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
研究设计回顾性队列研究:本研究旨在比较基于CT的计算机辅助导航(CAN)与传统椎弓根螺钉置入术对青少年特发性脊柱侧凸(AIS)患者的疗效:这项回顾性队列研究的数据来自2016-2019年的国家再入院数据库。通过ICD-10编码确定了接受CAN或透视引导手术后路融合治疗AIS的患者。为比较不同手术技术的结果,进行了多变量回归。负二项回归用于评估出院处置,伽马回归用于评估住院时间(LOS)和总费用。在回归分析中,我们对患者的人口统计学特征和合并症(通过 Elixhauser 合并症指数衡量)进行了控制。接受CAN手术的患者手术并发症增加(Odds Ratio (OR) 2.23; P < 0.001),其中输血并发症增加(OR 2.47; P < 0.001)。出院处置和住院时间相似,再次手术和再次入院率也相似;但CAN组的总费用明显更高(OR 1.37;P < 0.001)。传统手术的平均费用为191,489.42 (119,302.30) 美元,而CAN组的平均费用为268,589.86 (105,636.78) 美元:结论:CAN 用于 AIS 后路融合术似乎并不能减少术后并发症,反而会增加输血需求。考虑到 CAN 的总护理成本也要高得多,本研究对在这种情况下使用 CAN 是否合理提出了质疑。
Computer Assisted Navigation Does Not Improve Outcomes in Posterior Fusion for Adolescent Idiopathic Scoliosis.
Study design: Retrospective Cohort Study.
Objective: The aim of this study was to compare the efficacy of CT-based computer assisted navigation (CAN) to conventional pedicle screw placement for patients with Adolescent Idiopathic Scoliosis (AIS).
Methods: This retrospective cohort study drew data from the National Readmissions Database, years 2016-2019. Patients undergoing posterior fusion for AIS, either via CAN or fluoroscopic-guided procedures, were identified via ICD-10 codes. Multivariate regression was performed to compare outcomes between operative techniques. Negative binomial regression was used to asses discharge disposition, while Gamma regression was performed to assess length of stay (LOS) and total charges. Patient demographics and comorbidities, measured via the Elixhauser comorbidity index, were both controlled for in our regression analysis.
Results: 28,868 patients, 2095 (7.3%) undergoing a CAN procedure, were included in our analysis. Patients undergoing CAN procedures had increased surgical complications (Odds Ratio (OR) 2.23; P < 0.001), namely, blood transfusions (OR 2.47; P < 0.001). Discharge disposition and LOS were similar, as were reoperation and readmission rates; however, total charges were significantly greater in the CAN group (OR 1.37; P < 0.001). Mean charges were 191,489.42 (119,302.30) USD for conventional surgery vs 268 589.86 (105,636.78) USD for the CAN cohort.
Conclusion: CAN in posterior fusion for AIS does not appear to decrease postoperative complications and is associated with an increased need for blood transfusions. Given the much higher total cost of care that was also seen with CAN, this study calls into question whether the use of CAN is justified in this setting.
期刊介绍:
Global Spine Journal (GSJ) is the official scientific publication of AOSpine. A peer-reviewed, open access journal, devoted to the study and treatment of spinal disorders, including diagnosis, operative and non-operative treatment options, surgical techniques, and emerging research and clinical developments.GSJ is indexed in PubMedCentral, SCOPUS, and Emerging Sources Citation Index (ESCI).