Factors influencing length of stay following cervical spine surgery: A comparison of myelopathy and radiculopathy patients.

Autor: Pierce KE; Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, United States., Gerling MC; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States., Bortz CA; Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, United States., Alas H; Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, United States., Brown AE; Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, United States., Woo D; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States., Vasquez-Montes D; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States., Ayres EW; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States., Diebo BG; Deparment of Orthopedic Surgery, SUNY Downstate, New York, NY, United States., Maglaras C; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States., Janjua MB; Department of Pediatric Neurosurgery, UT Southwestern, Dallas, TX, United States., Buckland AJ; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States., Fischer CR; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States., Protopsaltis TS; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States., Passias PG; Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, United States. Electronic address: Peter.Passias@nyumc.org.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2019 Sep; Vol. 67, pp. 109-113. Date of Electronic Publication: 2019 Jun 15.
DOI: 10.1016/j.jocn.2019.06.009
Abstrakt: In the current value-based healthcare climate where spine surgery is shifting to the ambulatory setting, factors influencing postop length of stay (LOS) are important to surgeons and hospital administrators. Pre-op patient factors including diagnosis of radiculopathy and myelopathy have yet to be investigated in this context. Operative pts ≥ 18Y with primary diagnoses of cervical myelopathy (M), radiculopathy (R), or myeloradiculopathy (MR) were included and propensity score matched by invasiveness score (Mirza et al.). Top-quartile LOS was defined as extended. M&R patients were compared using Chi 2 & independent t-tests. Univariate tests assessed differences in preop patient and surgical data in M&R pts and extended/non-extended LOS. Stepwise regression analysis explored factors predictive of LOS. 718 operative pts (54.5 yrs, 41.1%F, 29.1 kg/m 2 , mean CCI 1.11) included (177 M, 383 R, and 158 MR). After PSM, 345 patients remained (115 in each diagnosis). 102 patients had E-LOS (Avg: 5.96 days), 41 M patients (mean 7.1 days), 28 R (5.9 days), and 33 MR (4.6 days). Regression showed predictors of E-LOS in R pts (R 2  = 0.532, p = 0.043): TS-CL, combined and posterior approach, LIV, UIV, op time, Lactated Ringer's, postoperative complications. Predictors of E-LOS in M pts (R 2  = 0.230, p < 0.001): age, CCI, combined and posterior approach, levels fused, UIV, EBL, neuro and any postop complications. Predictors of E-LOS in MR patients (R 2  = 0.152, p < 0.001): age, kyphosis, combined approach, UIV, LIV, levels fused, EBL and op time. Independent of invasiveness, patients with a primary diagnosis of myelopathy, though older aged and higher comorbidity profile, had consistently longer overall postop LOS when compared to radiculopathy or myeloradiculopathy patients.
(Copyright © 2019 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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