Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults.
Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults.
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DOI：
10.1001/jama.2010.338
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发表时间：
2010-04-07
影响因子：
120.7
通讯作者：
Jarvik, Jeffrey G.
中科院分区：
文献类型：
--
作者：
Deyo, Richard A.;Mirza, Sohail K.;Martin, Brook I.;Kreuter, William;Goodman, David C.;Jarvik, Jeffrey G.
近几十年来，腰椎手术增长最快的是老年椎管狭窄患者。试验表明，对于选定的患者，减压手术比非手术治疗更有优势，但外科医生通常推荐更具侵入性的融合手术。合并症在老年患者中很常见，因此在选择手术方法时必须仔细权衡利弊。检查不同类型狭窄手术的使用趋势以及并发症和资源使用与手术复杂性的关系。2002-2007年医疗保险索赔的回顾性队列分析，以2007年为重点评估美国医院的并发症和资源使用。2007年前11个月接受腰椎管狭窄手术的医疗保险受助者的手术（n= 32152）分为3个侵入性等级：单独减压，简单融合（一个或两个椎间盘节段，单一手术入路）或复杂融合（超过两个椎间盘节段或前后联合入路）。三种手术的发生率、主要并发症、术后死亡率和资源利用情况。总体而言，2002-2007年手术率略有下降，但复杂融合手术率增加了15倍，从每10万受益人1.3例增加到19.9例。危及生命的并发症随着手术侵入性的增加而增加，从单纯减压患者的2.3%增加到复杂融合患者的5.6%。在调整了年龄、合并症、既往脊柱手术和其他特征后，与单纯减压相比，复杂融合术中危及生命的并发症的优势比（OR）为2.95 （95% CI 2.50-3.49）。在30天内再次住院的患者中也观察到类似的模式，7.8%的减压患者和13.0%的复杂融合患者发生了这种情况（调整后的OR为1.94；95% CI为1.74-2.17）。复杂融合手术的调整后平均住院费用为80,888美元，而单纯减压手术的调整后平均住院费用为23,724美元。2002年至2007年间，在医疗保险接受者中，椎管狭窄复杂融合手术的频率增加，而减压手术和简单融合的频率减少。2007年，与减压相比，简单融合和复杂融合与主要并发症、30天死亡率和资源使用风险增加相关。
In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over non-operative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in elderly patients, so benefits and risks must be carefully weighed in the choice of surgical procedure. Examine trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity. Retrospective cohort analysis of Medicare claims for 2002–2007, focusing on 2007 to assess complications and resource use in U.S. hospitals. Operations for Medicare recipients undergoing surgery for lumbar stenosis (n=32,152 in the first 11 months of 2007) were grouped into 3 gradations of invasiveness: decompression alone, simple fusion (one or two disc levels, single surgical approach) or complex fusion (more than 2 disc levels or combined anterior and posterior approach). Rates of the 3 types of surgery, major complications, postoperative mortality, and resource use. Overall, surgical rates declined slightly from 2002–2007, but the rate of complex fusion procedures increased 15-fold, from 1.3 to 19.9 per 100,000 beneficiaries. Life-threatening complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex fusion compared to decompression alone was 2.95 (95% CI 2.50–3.49). A similar pattern was observed for rehospitalization within 30 days, which occurred for 7.8% of patients undergoing decompression and 13.0% having a complex fusion (adjusted OR 1.94; 95% CI 1.74–2.17). Adjusted mean hospital charges for complex fusion procedures were $80,888 compared to $23,724 for decompression alone. Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased, while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
DOI：
10.2106/00004623-200311000-00004
发表时间：
2003-11-01
影响因子：
5.3
作者：
Carreon, LY;Puno, RM;Johnson, JR
通讯作者：
Johnson, JR
DOI：
10.1097/01.blo.0000198726.62514.75
发表时间：
2006-02-01
影响因子：
4.2
作者：
Deyo, Richard A.;Mirza, Sohail K.
通讯作者：
Mirza, Sohail K.
影响因子：
3
作者：
Möller, H;Hedlund, R
通讯作者：
Hedlund, R
影响因子：
3
作者：
Fischgrund, JS;Mackay, M;Kurz, LT
通讯作者：
Kurz, LT