Predictors of Hospital-Acquired Conditions Are Predominately Similar for Spine Surgery and Other Common Elective Surgical Procedures, With Some Key Exceptions.

Autor:	Horn SR; NYU Medical Center, NY Spine Institute, New York, NY, USA., Pierce KE; NYU Medical Center, NY Spine Institute, New York, NY, USA., Oh C; NYU Langone Orthopaedic Hospital, New York, NY, USA., Segreto FA; NYU Medical Center, NY Spine Institute, New York, NY, USA., Egers M; NYU Langone Orthopaedic Hospital, New York, NY, USA., Bortz C; NYU Medical Center, NY Spine Institute, New York, NY, USA., Vasquez-Montes D; NYU Langone Orthopaedic Hospital, New York, NY, USA., Lafage R; NYU Langone Orthopaedic Hospital, New York, NY, USA., Lafage V; Hospital for Special Surgery, New York, NY, USA., Vira S; NYU Langone Orthopaedic Hospital, New York, NY, USA., Steinmetz L; NYU Langone Orthopaedic Hospital, New York, NY, USA., Ge DH; NYU Langone Orthopaedic Hospital, New York, NY, USA., Buza JA 3rd; NYU Langone Orthopaedic Hospital, New York, NY, USA., Moon J; NYU Langone Orthopaedic Hospital, New York, NY, USA., Diebo BG; SUNY Downstate Medical Center, Brooklyn, NY, USA., Alas H; NYU Medical Center, NY Spine Institute, New York, NY, USA., Brown AE; NYU Medical Center, NY Spine Institute, New York, NY, USA., Shepard NA; NYU Langone Orthopaedic Hospital, New York, NY, USA., Hassanzadeh H; University of Virginia, Charlottesville, VA, USA., Passias PG; NYU Medical Center, NY Spine Institute, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Global spine journal [Global Spine J] 2019 Oct; Vol. 9 (7), pp. 717-723. Date of Electronic Publication: 2019 Feb 05.
DOI:	10.1177/2192568219826083
Abstrakt:	Study Design: Retrospective review of a prospectively collected database. Objective: To predict the occurrence of hospital-acquired conditions (HACs) 30-days postoperatively and to compare predictors of HACs for spine surgery with other common elective surgeries. Methods: Patients ≥18 years undergoing elective spine surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2013. Outcome measures included any HACs: superficial or deep surgical site infection (SSI), venous thromboembolism (VTE), urinary tract infection (UTI). Spine surgery patients were compared with those undergoing other common procedures. Random forest followed by multivariable regression analysis was used to determine risk factors for the occurrence of HACs. Results: A total of 90 551 elective spine surgery patients, of whom 3021 (3.3%) developed at least 1 HAC, 1.4% SSI, 1.3% UTI, and 0.8% VTE. The occurrence of HACs for spine patients was predicted with high accuracy (area under the curve [AUC] 77.7%) with the following variables: female sex, baseline functional status, hypertension, history of transient ischemic attack (TIA), quadriplegia, steroid use, preoperative bleeding disorders, American Society of Anesthesiologists (ASA) class, operating room duration, operative time, and level of residency supervision. Functional status and hypertension were HAC predictors for total knee arthroplasty (TKA), bariatric, and cardiothoracic patients. ASA class and operative time were predictors for most surgery cohorts. History of TIA, preoperative bleeding disorders, and steroid use were less predictive for most other common surgical cohorts. Conclusions: Occurrence of HACs after spine surgery can be predicted with demographic, clinical, and surgical factors. Predictors for HACs in surgical spine patients, also common across other surgical groups, include functional status, hypertension, and operative time. Understanding the baseline patient risks for HACs will allow surgeons to become more effective in their patient selection for surgery. Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Peter G. Passias, MD, reports personal consulting fees for Spinewave, Zimmer Biomet, and Medicrea outside the submitted work. Virginie Lafage, PhD, is paid for lectures by Depuy Synthes, Nuvasive, K2M, and Medtronic and is a Nemaris Board member and shareholder.
Databáze:	MEDLINE
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