INFECTIOUS COMPLICATIONS OF SPINE SURGERY IN THE ELDERLY

描述（由申请人提供）：在过去的三十年中，脊柱手术在美国大幅增加，特别是在老年人中。脊柱手术后的伤口并发症可能与严重的发病率相关，包括严重的神经功能缺损、椎体不稳定和死亡。CDC估计，美国每年发生30万例手术部位感染。老年人手术部位感染的风险增加，死亡风险增加5倍，与感染相关的住院费用增加2倍。许多州最近颁布了立法，要求公众报告手术部位感染，一项新的CMS规则取消了一些手术后增加手术部位感染的医院支付。目前尚不清楚这些感染中有多少是可以预防的。目前还没有关于感染率变化的全国代表性数据，也没有既定的方法来对手术部位感染率进行风险分层，并根据患者组合和手术类型以及复杂性的差异进行调整。各机构报告的脊柱手术部位感染率存在显著差异（< 1- 15%）。尽管存在这种变异性，但根据特定外科医生或医院特征分析脊柱手术后手术部位感染和非感染性伤口并发症风险的数据很少。本提案的目的是使用2000-2005年老年人脊柱手术的医疗保险索赔数据来确定：1a）术后手术部位感染和非感染性伤口并发症的发生率，B）这些并发症的临床结局，包括再次入院、重复手术和死亡率，c）外科医生和医院感染性与非感染性伤口并发症比率的变化，以及2）多个层面（包括患者层面）的手术部位感染和非感染性伤口并发症的风险因素（年龄、手术类型和原因、合并症、既往感染和疾病严重程度）、外科医生水平（执业时间、专业和手术量）和医院水平（医院规模、教学状况、手术量和国家地区）。这些研究的结果将指导未来的研究，以改善手术护理过程，并为公共报告感染的医疗保健政策提供信息，目的是减少残疾，提高接受脊柱手术的老年人的生活质量。公共卫生相关性：本研究的目的是确定脊柱手术后伤口感染和其他伤口并发症的发生率是否因外科医生和医院而异，并确定与老年人这些并发症风险增加相关的患者、外科医生和医院因素。这项研究的结果最终将用于提高脊柱手术患者的护理质量。

DESCRIPTION (provided by applicant): Spine surgery increased substantially in the U.S. during the past three decades, particularly in the elderly. Wound complications after spinal surgery can be associated with significant morbidity, including serious neurologic deficit, vertebral instability, and death. CDC estimates 300,000 surgical site infections occur annually in the U.S. The elderly are at increased risk for surgical site infections and have a 5-fold higher risk of death and 2-fold higher hospital costs associated with infection. Many states have recently enacted legislation mandating public reporting of surgical site infections, and a new CMS rule eliminates increased hospital payment for surgical site infections following some surgeries. It is unclear how many of these infections are potentially preventable. There are no nationally representative data on variation in infection rates and no established methods to risk-stratify surgical site infection rates, adjusting for differences in patient mix and type and complexity of surgery. There is marked variability (< 1- 15%) in reported spinal surgical site infection rates from individual institutions. Despite this variability, there are little data on risk of surgical site infection and noninfectious wound complications after spine surgery analyzed by specific surgeon or hospital characteristics. The aims of this proposal are to use Medicare claims data for spine surgery performed in elderly persons from 2000-2005 to determine: 1a) the incidence of postoperative surgical site infection and noninfectious wound complications, b) clinical outcomes of these complications, including hospital readmission, repeat surgery, and mortality, c) variation in the ratio of infectious to noninfectious wound complications by surgeon and hospital, and 2) risk factors for surgical site infection and noninfectious wound complications at multiple levels, including patient-level (age, type and reason for surgery, co-morbidities, previous infections, and severity of illness), surgeon-level (time in practice, specialty, and surgery volume), and hospital-level (hospital size, teaching status, surgery volume, and region of the country). The results of these studies will guide future research to improve processes of surgical care and inform health care policy regarding public reporting of infections, with the goal to reduce disability and improve quality of life for the elderly undergoing spine surgery. Public Health Relevance: The goals of this study are to determine if the occurrence of wound infections and other wound complications after spine surgery varies across surgeons and across hospitals, and to determine patient, surgeon, and hospital factors associated with increased risk of these complications in elderly persons. The results of this study will ultimately be used to improve the quality of care provided to spine surgery patients.