2008年至2021年美国术中神经监测应用的趋势和人口统计学差异

IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY
Ali Al-Salahat, Danielle B Dilsaver, Yu-Ting Chen, Rohan Sharma, Nidhi Kapoor, Evanthia Bernitsas
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引用次数: 0

摘要

目的:术中神经监测(IONM)是在各种手术过程中监测神经轴和指导手术并发症干预的有价值的工具。文献缺乏关于美国IONM使用趋势和人口差异的大规模数据。方法:数据提取自2008-2021年全国住院患者样本。神经外科(脊柱、开颅、颈动脉、颅/周围神经)、心脏/血管和头颈部/甲状腺手术的住院情况被IONM确定并分层。估计逻辑回归模型来评估IONM使用的差异和趋势。多变量模型调整病人和设施水平的特点。结果:从2008年到2021年,IONM在神经外科(3.69%至18.62%,p < 0.001)和心脏/血管手术(0.018%至0.6%,p < 0.001)中的使用率显著增加。IONM在头颈甲状腺手术中的使用在2014年之前稳步增加,然后下降(p < 0.001)。与住院的白人患者相比,黑人(aOR = 0.87, 95% CI: 0.81-0.94)和西班牙裔(aOR = 0.88, 95% CI: 0.81-0.96)患者在开颅术中使用IONM的几率较低。较低的收入(0-25分位数)与脊柱(aOR = 0.83, 95% CI: 0.78-0.88)和开颅手术(aOR = 0.78, 95% CI: 0.72-0.85)使用IONM的几率较低相关。结论:对IONM的需求不断增长,以提高各种手术的安全性,这表明需要具有这方面专业知识的神经科医生和技术专家。此外,我们发现IONM的使用存在显著的种族/民族和社会经济差异。这些发现对于卫生保健管理人员和政策制定者解决在获取IONM方面的差异是有价值的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trends and Demographic Disparities in the Utilization of Intraoperative Neuromonitoring in the United States, 2008 to 2021.

Purpose: Intraoperative neuromonitoring (IONM) is a valuable tool to monitor the neural axis during various procedures and guide intervention aimed at managing operative complications. The literature lacks large scale data on trends and demographic disparities in IONM use in the United States.

Methods: Data were abstracted from the 2008-2021 National Inpatient Sample. Hospitalizations for neurosurgical (spinal, craniotomy, carotid artery, cranial/peripheral nerve), cardiac/vascular, and head/neck/thyroid procedures were identified and stratified by IONM use. Logistic regression models were estimated to assess disparities and trends in IONM use. Multivariable models adjusted for patient- and facility-level characteristics.

Results: From 2008 to 2021, the rate of IONM use increased significantly in neurosurgical (3.69% to 18.62%, p < 0.001) and cardiac/vascular procedures (0.018% to 0.6%, p < 0.001). IONM use for head/neck/thyroid procedures increased steadily until 2014 and then declined (p < 0.001). Compared with hospitalizations of White patients, Black (aOR = 0.87, 95% CI: 0.81-0.94) and Hispanic (aOR = 0.88, 95% CI: 0.81-0.96) patients were associated with lower odds of IONM use during craniotomy. Lower incomes (0-25th quartile) were associated with lower odds of IONM use in both spinal (aOR = 0.83, 95% CI: 0.78-0.88) and craniotomy procedures (aOR = 0.78, 95% CI: 0.72-0.85).

Conclusions: There is a growing demand for IONM to enhance the safety of various procedures, indicating a need for neurologists and technologists with this expertise. In addition, we found significant racial/ethnic and socioeconomic disparities in IONM use. These findings can be valuable for health care administrators and policymakers to address disparities in the access to IONM.

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来源期刊
Journal of Clinical Neurophysiology
Journal of Clinical Neurophysiology 医学-临床神经学
CiteScore
4.60
自引率
4.20%
发文量
198
审稿时长
6-12 weeks
期刊介绍: ​The Journal of Clinical Neurophysiology features both topical reviews and original research in both central and peripheral neurophysiology, as related to patient evaluation and treatment. Official Journal of the American Clinical Neurophysiology Society.
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