Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

Autor: Michael P. Steinmetz, Kelsey A. Isbester, Thomas E. Mroz, Joseph E. Tanenbaum
Rok vydání: 2018
Předmět:
Zdroj: The Spine Journal. 18:S186-S187
ISSN: 1529-9430
DOI: 10.1016/j.spinee.2018.06.638
Popis: BACKGROUND CONTEXT Understanding the timing of adverse event onset is a critical component of post-surgical care and discharge planning. As health-care systems continue to evolve toward rewarding quality of care through episode and bundled payments, spine surgeons face increasing pressure to minimize hospital length of stay following common yet costly procedures such as cervical laminoplasty. Although prior studies outline the incidence and predictors of postoperative complications following cervical laminoplasty, the time elapsed between surgery and adverse event onset remains unknown. PURPOSE To characterize the timing of postoperative complications following cervical laminoplasty. STUDY DESIGN/SETTING Retrospective cohort analysis using the 2012-2015 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. PATIENT SAMPLE The study included 1,243 patients undergoing cervical laminoplasty. OUTCOME MEASURES Outcome measures were rate and timing of postoperative complications, readmission, and reoperation. METHODS A retrospective cohort analysis of the NSQIP database for 2012-2015 was performed. Data from patients undergoing cervical laminoplasty was extracted with 12 outcomes selected a priori: stroke or CVA, MI,pneumonia, pulmonary embolism, UTI, deep vein thrombosis requiring therapy, sepsis, superficial SSI, deep SSI, organ space SSI, unplanned reoperation, and hospital readmission. Analysis was done to determine rate of adverse events, timing to adverse events, 30-day readmission rates and timing, and 30-day unplanned reoperation rates and timing. RESULTS A total of 1,243 patients undergoing cervical laminoplasty were identified for this study. The median day of diagnosis (lower quartile-upper quartile) for myocardial infarction was 2days (1–7 days), for pneumonia 4days (1–6 days), for pulmonary embolism 4days (3–13 days), for stroke or CVA 8 (4–14 days), unplanned reoperation 9.5 (4–16 days), urinary tract infection 10.5 (4–14.5 days), readmission 14 (6.5–18.5 days), deep incisional surgical site infection 16.5 (12–19 days), organ or space surgical site infection 18 (15–21 days), sepsis 18 (8–21 days), and superficial incisional surgical site infection 24 (20–26 days). CONCLUSIONS A value-based health-care system requires that physicians optimize patient outcomes while containing costs wherever possible. Decreasing postoperative length of stay has been a major focus of hospital systems and surgeons in their response to emerging alternative payment models. However, outcome-based reimbursement and penalties for hospital readmissions necessitate that surgeons not discharge a patient prematurely. The results of this study can help improve clinical decision-making by identifying the typical time frame during which adverse events develop following cervical laminoplasty.
Databáze: OpenAIRE
Externí odkaz: