Renaud Lafage, Connor Sheehan, Justin S Smith, Alan Daniels, Bassel Diebo, Christopher Ames, Shay Bess, Robert Eastlack, Munish Gupta, Richard Hostin, Han Jo Kim, Eric Klineberg, Gregory Mundis, Kojo Hamilton, Christopher Shaffrey, Frank Schwab, Virginie Lafage, Douglas Burton
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引用次数: 0
Abstract
Study design: Retrospective Cohort Study.
Objectives: Length of Stay (LOS) and resource utilization are of primary importance for hospital administration. This study aimed to understand the incremental effect of having a specific complication on LOS among ASD patients.
Methods: A retrospective examination of prospective multicenter data utilized patients without a complication prior to discharge to develop a patient-adjusted and surgery-adjusted predictive model of LOS among ASD patients. The model was later applied to patients with at least 1 complication prior to discharge to investigate incremental effect of each identified complication on LOS vs the expected LOS.
Results: 571/1494 (38.2%) patients experienced at least 1 complication before discharge with a median LOS of 7 [IQR 5 to 9]. Univariate analysis demonstrated that LOS was significantly affected by patients' demographics (age, CCI, sex, disability, deformity) and surgical strategy (invasiveness, fusion length, posterior MIS fusion, direct decompression, osteotomy severity, IBF use, EBL, ASA, ICU stay, day between stages, Date of Sx). Using patients with at least 1 complication prior discharge and compared to the patient-and-surgery adjusted prediction, having a minor complication increased the expected LOS by 0.9 day(s), a major complication by 3.9 days, and a major complication with reoperation by 6.3 days.
Conclusion: Complications following surgery for ASD correction have different, but predictable impact on LOS. Some complications requiring minimal intervention are associated with significant and substantial increases in LOS, while complications with significant impact on patient quality of life may have no influence on LOS.
研究设计研究目的:回顾性队列研究:住院时间(LOS)和资源利用率是医院管理的重中之重。本研究旨在了解特定并发症对 ASD 患者 LOS 的增量影响:对前瞻性多中心数据进行了回顾性检查,利用出院前无并发症的患者建立了一个根据患者和手术调整的 ASD 患者 LOS 预测模型。随后将该模型应用于出院前至少有一种并发症的患者,以研究每种已确定的并发症对 LOS 的增量影响与预期 LOS 的对比:571/1494(38.2%)例患者在出院前至少出现过一种并发症,中位住院日为 7 天[IQR 5 至 9 天]。单变量分析表明,患者的人口统计学特征(年龄、CCI、性别、残疾、畸形)和手术策略(侵入性、融合长度、后路 MIS 融合、直接减压、截骨严重程度、IBF 使用、EBL、ASA、ICU 留院时间、各阶段之间的间隔天数、手术日期)对 LOS 有明显影响。如果患者在出院前至少发生过一次并发症,那么与患者和手术调整后的预测结果相比,轻微并发症会使预期LOS增加0.9天,严重并发症会增加3.9天,严重并发症并再次手术会增加6.3天:ASD矫正手术后的并发症对住院时间的影响各不相同,但都是可以预测的。一些只需极少干预的并发症会显著增加患者的住院时间,而对患者生活质量有重大影响的并发症可能不会影响患者的住院时间。