Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40-64 years, 2010-2014.
Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40-64 years, 2010-2014.
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2010-2014 年美国 40-64 岁在职成年人孤立性腰椎管狭窄手术的趋势。
DOI：
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
R. Skolasky
中科院分区：
文献类型：
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作者：
M. Raad;C. Donaldson;Mostafa H. El Dafrawy;D. Sciubba;L. Riley;Brian J. Neuman;K. Kebaish;R. Skolasky
目的推荐孤立性腰椎管狭窄症（LSS）的手术治疗方法（即，在没有伴随的脊柱侧凸或脊椎前移的情况下）尚不清楚。本研究的目的是调查美国成人孤立性LSS的手术治疗趋势，并确定对结局的影响。方法：作者分析了Truven Health Analytics MarketScan商业索赔和遭遇数据库中20，279名年龄在40-64岁之间的患者的住院和门诊索赔，这些患者在2010年至2014年期间接受了LSS手术。仅纳入术后连续12个月保险覆盖的患者。按年份和地理区域分析关节融合术与单纯减压术的减压率，以及简单（单节段或双节段，单入路）与复杂（>双节段或联合入路）关节融合术的减压率。进一步分析了这些趋势，包括并发症、住院时间、向医院支付的费用和患者出院状态。统计学显著性设定为p < 0.05。结果：2010年至2014年，与单纯减压相比，接受关节融合减压的患者比例显著线性增加（OR 1.08; 95% CI 1.06-1.10）。关节融合术在随后的每一年都更可能是复杂的而不是简单的（OR 1.4; 95% CI 1.33-1.49）。这种趋势伴随着术后并发症的可能性增加（OR 1.11; 95% CI 1.02-1.21），费用较高（支付平均每年增加1633美元; 95% CI 1327-1939），出院到专业护理机构而不是在家的可能性更大（OR 1.11; 95% CI 1.03-1.20）。美国南部和中西部地区接受关节融合术的患者比例最高（分别为48%和42%）。平均住院时间无显著变化（p = 0.324）。结论：从2010年到2014年，接受关节融合减压术与仅接受减压术治疗LSS的成人比例增加，尤其是在美国南部和中西部地区。这些融合术中更大比例是复杂的，并且与更多并发症、更高的成本和更大的出院到专业护理机构的可能性相关。
OBJECTIVE Recommendations for the surgical treatment of isolated lumbar spinal stenosis (LSS) (i.e., in the absence of concomitant scoliosis or spondylolisthesis) are unclear. The aims of this study were to investigate trends in the surgical treatment of isolated LSS in US adults and determine implications for outcomes. METHODS The authors analyzed inpatient and outpatient claims from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database for 20,279 patients aged 40-64 years who underwent surgery for LSS between 2010 and 2014. Only patients with continuous 12-month insurance coverage after surgery were included. The rates of decompression with arthrodesis versus decompression only and of simple (1- or 2-level, single-approach) versus complex (> 2-level or combined-approach) arthrodesis were analyzed by year and geographic region. These trends were further analyzed with respect to complications, length of hospital stay, payments made to the hospital, and patient discharge status. Statistical significance was set at p < 0.05. RESULTS The proportion of patients who underwent decompression with arthrodesis compared with decompression only increased significantly and linearly from 2010 to 2014 (OR 1.08; 95% CI 1.06-1.10). Arthrodesis was more likely to be complex rather than simple with each subsequent year (OR 1.4; 95% CI 1.33-1.49). This trend was accompanied by an increased likelihood of postoperative complications (OR 1.11; 95% CI 1.02-1.21), higher costs (payments increased by a mean of US$1633 per year; 95% CI 1327-1939), and greater likelihood of being discharged to a skilled nursing facility as opposed to home (OR 1.11; 95% CI 1.03-1.20). The South and Midwest regions of the US had the highest proportions of patients undergoing arthrodesis (48% and 42%, respectively). The mean length of hospital stay did not change significantly (p = 0.324). CONCLUSIONS From 2010 to 2014, the proportion of adults undergoing decompression with arthrodesis versus decompression only for the treatment of LSS increased, especially in the South and Midwest regions of the US. A greater proportion of these fusions were complex and were associated with more complications, higher costs, and a greater likelihood of being discharged to a skilled nursing facility.
影响因子：
120.7
作者：
Deyo, Richard A.;Mirza, Sohail K.;Martin, Brook I.;Kreuter, William;Goodman, David C.;Jarvik, Jeffrey G.
通讯作者：
Jarvik, Jeffrey G.
影响因子：
158.5
作者：
Weinstein, James N.;Tosteson, Tor D.;An, Howard
通讯作者：
An, Howard
南澳大利亚腰椎手术的小区域分析。
DOI：
10.1111/j.1445-2197.1993.tb00026.x
发表时间：
1993
期刊：
The Australian and New Zealand journal of surgery
影响因子：
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作者：
Loeser,JD;VanKonkelenberg,R;Volinn,E;Cousins,MJ
通讯作者：
Cousins,MJ