INFECTIOUS COMPLICATIONS OF SPINE SURGERY IN THE ELDERLY

老年人脊柱手术的感染性并发症

• 批准号: 7800396
• 负责人: MARGARET A OLSEN
• 金额: $ 16.93万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7800396
• 关键词: Accounting; Age; Anterior; Back Pain; Caring; Centers for Disease Control and Prevention (U.S.); Cervical spine; Cessation of life; Characteristics; Clinical; Common Cold; Comorbidity; Complication; Country; Data; Day Surgery; Degenerative Disorder; Educational process of instructing; Elderly; Future; Geographic Locations; Goals; Health Policy; Hospital Costs; Hospital Sizes; Hospitals; Incidence; Individual; Infection; Institution; Knowledge; Length of Stay; Medical; Medicare claim; Methods; Morbidity - disease rate; Neurologic Deficit; Nosocomial Infections; Office Visits; Operative Surgical Procedures; Outcome; Outcome Study; Outpatients; Patients; Persons; Physicians; Plant Roots; Population; Postoperative Period; Probability; Process; Provider; Pseudarthrosis; Quality of Care; Quality of life; Repeat Surgery; Reporting; Research; Risk; Risk Factors; Severity of illness; Site; Spinal; Spinal Fusion; Statutes and Laws; Surgeon; Surgical Specialties; Thoracic Surgical Procedures; Time; United States Centers for Medicare and Medicaid Services; Variant; Vertebral column; Visit; Wound Infection; adverse outcome; cost; disability; high risk; hospital readmission; improved; instrumentation; mortality; patient population; payment; population based; prevent; public health relevance; spine bone structure; surveillance strategy; therapy design; vertebra body; wound

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.

描述（由申请人提供）：在过去的三十年中，脊柱外科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显著的发病率相关，包括严重的神经功能缺损、椎体不稳定和死亡。美国疾病控制与预防中心估计，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，要求公开报告手术部位感染，新的CMS规则消除了一些手术后手术部位感染的医院支付增加。目前尚不清楚这些感染中有多少是可以预防的。没有关于感染率变化的具有全国代表性的数据，也没有既定的方法来对手术部位感染率进行风险分层，以调整患者组合、手术类型和复杂性的差异。在各个机构报告的脊柱手术部位感染率有明显的差异（< 1- 15%）。尽管存在这种可变性，但根据特定的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的风险的数据很少。本提案的目的是利用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果，包括再入院、重复手术和死亡率，c)不同外科医生和医院的感染性和非感染性伤口并发症比例的变化，以及2)手术部位感染和非感染性伤口并发症的多个层面的危险因素，包括患者层面(年龄、手术类型和原因、合并症、既往感染，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，以改善外科护理过程，并为公共报告感染的卫生保健政策提供信息，目标是减少残疾，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不同外科医生和医院脊柱手术后伤口感染和其他伤口并发症的发生率是否不同，并确定患者、外科医生和医院因素与老年人这些并发症风险增加相关。本研究的结果最终将用于提高脊柱手术患者的护理质量。