Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions
Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions
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DOI：
10.3171/2014.10.spine14228
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发表时间：
2015-04-01
影响因子：
2.8
通讯作者：
Mroz, Thomas E.
中科院分区：
文献类型：
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作者：
Kuhns, Benjamin D.;Lubelski, Daniel;Mroz, Thomas E.
脊柱手术后的器官感染对患者的生活质量（QOL）产生负面影响，并给医疗保健系统带来重大的经济负担。颈椎背侧手术后伤口感染的发生率高于腹侧手术。量化颈背部手术后与感染相关的健康结果和成本可能有助于指导治疗策略，以最大限度地减少这些感染的有害后果。因此，本研究的目的是确定成本和生活质量的结果，影响患者发生深部伤口感染后，下背颈椎fusions.METHODS的作者确定了22（4.0%）的551例患者进行背颈椎融合谁开发的深部伤口感染需要手术清创。这些患者与未发生感染的对照患者单独匹配。使用EQ-5D、疼痛残疾问卷（PDQ）、患者健康问卷（PHQ-9）和视觉模拟量表（VAS）评估健康结局。在术前、术后6个月和12个月收集QOL结局指标。在平均18个月的随访期间，从患者电子病历中记录卫生资源利用情况。直接成本估计使用医疗保险国家支付金额，和间接成本的基础上，患者的错过工作日和income.RESULTS术前生活质量评分无显着差异，发现2个队列。术后6个月时，非感染队列的EQ-5D从术前到术后有显著改善（p = 0.02），而感染队列没有改善（p = 0.2）。非感染队列的术后6个月EQ-5D评分也显著高于感染队列（p = 0.04）。术后1年时，两组的EQ-5D评分无显著差异。感染队列的医疗保健相关费用显著较高（16，970美元vs 7658美元; p < 0.0001）。感染队列和非感染队列的间接成本分别为5495美元和2756美元（p = 0.03）。经通货膨胀调整后，感染队列的总成本为21，778美元，而非感染队列为9159美元，反映了术后深部伤口感染的平均成本为12，619美元结论：颈背部感染会暂时降低患者术后生活质量，但无长期影响;然而，它们确实大大增加了护理费用。了解颈背融合后伤口感染的经济负担可能会刺激开发和使用改进的预防和治疗技术来管理这种严重并发症。
OBJECT Infections following spine surgery negatively affect patient quality of life (QOL) and impose a significant financial burden on the health care sytem. Postoperative wound infections occur at higher rates following dorsal cervical procedures than ventral procedures. Quantifying the health outcomes and costs associated with infections following dorsal cervical procedures may help to guide treatment strategies to minimize the deleterious consequences of these infections. Therefore, the goals of this study were to determine the cost and QOL outcomes affecting patients who developed deep wound infections following subaxial dorsal cervical spine fusions.METHODS The authors identified 22 (4.0%) of 551 patients undergoing dorsal cervical fusions who developed deep wound infections requiring surgical debridement. These patients were individually matched with control patients who did not develop infections. Health outcomes were assessed using the EQ-5D, Pain Disability Questionnaire (PDQ), Patient Health Questionnaire (PHQ-9), and visual analog scale (VAS). QOL outcome measures were collected preoperatively and after 6 and 12 months. Health resource utilization was recorded from patient electronic medical records over an average follow-up of 18 months. Direct costs were estimated using Medicare national payment amounts, and indirect costs were based on patients' missed workdays and income.RESULTS No significant differences in preoperative QOL scores were found between the 2 cohorts. At 6 months post-surgery, the noninfection cohort had significant pre- to postoperative improvement in EQ-5D (p = 0.02), whereas the infection cohort did not (p = 0.2). The noninfection cohort also had a significantly higher 6-month postoperative EQ-5D scores than the infection cohort (p = 0.04). At 1 year postsurgery, there was no significant difference in EQ-5D scores between the groups. Health care associated costs for the infection cohort were significantly higher ($16,970 vs $7658; p < 0.0001). Indirect costs for the infection cohort and the noninfection cohort were $5495 and $2756, respectively (p = 0.03). Adjusted for inflation, the total costs for the infection cohort were $21,778 compared with $9159 for the noninfection cohort, reflecting an average cost of $12,619 associated with developing a postoperative deep wound infection (p < 0.0001).CONCLUSIONS Dorsal cervical infections temporarily decrease patient QOL postoperatively, but with no long-term impact; they do, however, dramatically increase the cost of care. Knowledge of the financial burden of wound infections following dorsal cervical fusion may stimulate the development and use of improved prophylactic and therapeutic techniques to manage this serious complication.