The risk of risk-adjustment measures for perioperative spine infection after spinal surgery.
The risk of risk-adjustment measures for perioperative spine infection after spinal surgery.
复制标题
脊柱手术后围手术期脊柱感染的风险调整措施的风险。
DOI：
10.1097/brs.0b013e3181e030b3
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发表时间：
2011
期刊：
影响因子：
3
通讯作者：
Richardson,William
中科院分区：
文献类型：
--
作者：
Goode,AdamP;Cook,Chad;Gill,JBrian;Tackett,Sean;Brown,Christopher;Richardson,William
研究设计：对全国住院患者样本（NIS）的横断面数据分析。目的：建立一个针对围手术期脊柱感染的风险调整指数，并将该指数与Deyo Comorrhage指数进行比较。评估特定的死亡率和发病率调整教学和nonteaching facilities.Summary of Background Data. Risk-adjustment measures之间的背景资料已经制定了专门的死亡率和可能不够敏感，以调整发病率在所有diagnosis.Methods.This condition specific index was developed by using the NIS in a two-step process to determine confiners and weighting.对Deyo和特定疾病指数的原始和调整点估计值进行常规出院、死亡、住院时间和总住院费用的比较，然后按教学医院状态分层。结果：1988年至2007年期间，NIS数据库中1，212，241例手术中共发生23，846例围手术期脊柱感染事件。23个诊断构成了这个特定条件指数。非教学医院的总费用和住院时间（P< 0.001）和教学医院的死亡、住院时间和总费用（P< 0.001）之间的Deyo和条件特异性指数之间存在显著差异。第一，当发病率存在问题时，针对具体情况的措施可能是有用的。第二，特定条件的围手术期脊柱感染调整指数似乎在调整合并症方面更敏感。最后，即使经过调整，教学医院和非教学医院的围手术期脊柱感染的医院处置特征也存在固有差异。
Study Design.Cross-sectional data analysis of the Nationwide Inpatient Sample (NIS).Objective.To develop a risk-adjustment index specific for perioperative spine infection and compare this specific index to the Deyo Comorbidity Index. Assess specific mortality and morbidity adjustments between teaching and nonteaching facilities.Summary of Background Data.Risk-adjustment measures have been developed specifically for mortality and may not be sensitive enough to adjust for morbidity across all diagnosis.Methods.This condition-specific index was developed by using the NIS in a two-step process to determine confounders and weighting. Crude and adjusted point estimates for the Deyo and condition-specific index were compared for routine discharge, death, length of stay, and total hospital charges and then stratified by teaching hospital status.Results.A total of 23,846 perioperative spinal infection events occurred in the NIS database between 1988 and 2007 of 1,212,241 procedures. Twenty-three diagnoses made up this condition-specific index. Significant differences between the Deyo and the condition-specific index were seen among total charges and length of stay at nonteaching hospitals (P< 0.001) and death, length of stay, and total charges (P< 0.001) for teaching hospitals.Conclusion.This study demonstrates several key points. One, condition-specific measures may be useful when morbidity is of question. Two, a condition-specific perioperative spine infection adjustment index appears to be more sensitive at adjusting for comorbidities. Finally, there are inherent differences in hospital disposition characteristics for perioperative spine infection across teaching and nonteaching hospitals even after adjustment.