骨科专科医院与三级转诊中心单层腰椎融合术后一年的患者报告结果对比。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal Pub Date : 2024-12-01 DOI:10.1016/j.spinee.2024.08.024

Rajkishen Narayanan MD, Teeto Ezeonu BA, Jeremy C. Heard BS, Yunsoo Lee MD, Azra Dees, Goutham Yalla BS, Jose A. Canseco MD, PhD, Mark F. Kurd MD, Ian David Kaye MD, Barrett I. Woods MD, Alan S. Hilibrand MD, Alexander R. Vaccaro MD, PhD, MBA, Gregory D. Schroeder MD, Christopher K. Kepler MD, MBA

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引用次数: 0

摘要

背景情况：腰椎融合术是治疗脊柱退行性病变相关症状（包括根性病变和疼痛）的一种越来越常见的手术。随着脊柱手术量的增加，在包括骨科专科医院（OSH）在内的非三级医疗中心进行手术变得越来越普遍。虽然之前的研究表明，骨科专科医院的手术效果并不亚于三级转诊中心（TRC），但这种差异对患者报告结果指标（PROMs）的影响尚未得到充分评估。目的：本研究的目的是：（1）确定在骨科专科医院（OSH）接受手术的患者与在三级转诊中心（TRC）接受手术的患者在选择性腰椎融合手术后患者报告的结果指标（PROMs）的变化是否不同；（2）描述不同医院之间短期结果的差异：研究设计：回顾性队列研究：研究设计：回顾性队列研究。患者样本：2014年1月至2021年12月期间在三级转诊中心或骨科专科医院接受初级、择期单侧腰椎后路减压和融合术的成年患者（≥18岁）：PROMs：Oswestry残疾指数（ODI）、短表12（SF12）精神成分摘要（MCS）、SF12躯体成分摘要（PCS）、视觉模拟背腿（VAS背/腿）方法：收集术前、术后6个月和术后1年的PROMs。将术前 PROM 评分减去 6 个月或 1 年的评分，分别计算出 6 个月和 1 年的 PROM delta 值。进行了多变量线性回归分析，以评估医院位置对术后 PROM 评分的独立影响：共有288名患者被纳入研究队列，其中205名患者在三甲医院接受手术，83名患者在职业安全医院接受手术。OSH 患者的住院时间较短（1.57 ± 0.72 vs. 3.28 ± 1.32，P0.05）。6 个月后，在专科医院接受手术的患者 PCS 值更高（估计值 = 2.96，置信区间：0.21 - 5.71，P=0.035）。术后 1 年，手术地点与 PROM 评分的关系不再显著。术前 PROM 评分与每项 PROM 的 6 个月和 1 年评分均有显著相关性（p 结论：据我们所知，这是针对单椎段腰椎融合术中OSH与TRC的PROM进行的最大规模研究之一。我们的研究表明，在一年的随访中，在TRC接受手术的患者与在OSH接受手术的患者在PROM改善方面没有明显差异。

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One-year patient reported outcomes after single-level lumbar fusion at orthopedic specialty hospital compared to tertiary referral center

BACKGROUND CONTEXT

Lumbar spinal fusion is an increasingly common operation to treat symptoms related to degenerative disorders of the spine including radiculopathy and pain. As the volume of spine surgeries grows, it is becoming increasingly common for procedures to take place in nontertiary care centers, including orthopaedic specialty hospitals (OSH). While previous research demonstrates that surgical outcomes at an OSH are noninferior to those at a tertiary referral center (TRC), the implications of this difference on patient-reported outcome measures (PROMs) have not been sufficiently assessed.

PURPOSE

The objectives of this study were (1) to determine if changes in patient reported outcome measures (PROMs) after elective lumbar spinal fusion surgery differ between patients who undergo surgery at an orthopedic specialty hospital (OSH) and those who undergo surgery at a tertiary referral center (TRC) and (2) to characterize differences in short-term outcomes between hospitals.

STUDY DESIGN

Retrospective cohort study.

PATIENT SAMPLE

Adult patients (≥18 years old) who underwent primary, elective single-level posterior lumbar decompression and fusion between January 2014 and December 2021 at a tertiary referral center or an orthopaedic specialty hospital.

OUTCOME MEASURES

PROMs: Oswestry Disability Index (ODI), Short-form 12 (SF12) Mental Component Summary (MCS); SF12 Physical Component Summary (PCS); Visual Analogue Back and Leg (VAS Back/Leg).

METHODS

PROMs were collected preoperatively, 6 months after surgery, and 1 year after surgery. Six-month and 1-year delta PROM values were calculated by subtracting the preoperative PROM score from the 6-month or 1-year score, respectively. Multivariable linear regression analyses were conducted to assess the independent effect of hospital location on postoperative PROM scores.

RESULTS

A total of 288 patients were identified as part of the study cohort including 205 patients who underwent surgery at the tertiary hospital and 83 patients who underwent surgery at the OSH. OSH patients had shorter length of stay (1.57±0.72 vs 3.28±1.32, p<.001), however there was no difference in discharge disposition or 90-day readmission rates between hospitals (p>.05). At 6 months, having surgery at the specialty hospital was associated with higher PCS (estimate=2.96, confidence interval: 0.21–5.71, p=.035). At 1-year postoperatively, the location of surgery no longer demonstrated significant associations with PROM scores. Preoperative PROM scores demonstrated significant associations with 6-month and 1-year scores for each PROM (p<.05) except VAS leg at 6 months postoperatively.

CONCLUSION

To our knowledge, this is one of the largest studies investigating PROMs at OSH versus TRCs for single-level lumbar fusions. We demonstrated that at 1-year follow-up, there is not a significant difference in PROM improvement between patients who undergo surgery at a TRC and patients who do so at an OSH.

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来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.