Degenerative Cervical Spondylosis:Neuro-surgical Interventions and Medical Cost

Autor: Yu-Tung Feng, 馮玉東
Rok vydání: 2011
Druh dokumentu: 學位論文 ; thesis
Popis: 99
OBJECTIVE. Actually part of aging process, degenerative cervical spondylosis (DCS) is the most common reason for degenerative changes with the spinal column. Operative intervention is considered when the severely pain is not relieved by non-operative treatment. Either with anterior or posterior approach, cervical discectomy and fusion is main option typically considered for operative management of DCS. It is predictable that resource utilization would be impacted with the aging population. The purposes of the research are: 1) to describe the distribution of a selective DCS patients receiving operative intervention of different surgical approaches at our institution, 2) to study the medical results of the above-mentioned patients’, 3) to study the resource utilization of the above-mentioned patients’, 4) to identify factors related to the medical results of the above-mentioned patients’, 5) to identify factors related to the resource utilization of the above-mentioned patients’. METHODS. This is a retrospective chart review within a medical center of patients undergoing instrumented procedures using allografts. The sample included 145 patients who underwent anterior cervical discectomy and fusion and/or posterior laminectomy and fusion procedures from January 2009 to December 2011. Patients with degenerative changes involved cervical intervertebral levels of C1-C2, spinal injury traumatic in origin, spinal tumors, or previous cervical fusion were excluded. Information regarding age, gender, medical comorbidity (Charlson Comorbidity Index), history of smoking/alcohol consumption, body mass index (BMI), anesthesical details and surgical details were collected. Complications after surgery as well as immediate re-operation for any reason were defined as indicators to medical results, in addition, anesthesia duration, operation duration, hospital length of stay, hospital cost, and reimbursement of national health insurance were noted to define the resource utilization. All these parameters were used to evaluate the impact of surgical intervention on the outcomes. All tests were performed at the 0.05 level of significance. RESULTS. Met with the inclusion criteria, one hundred and five patients (97 in the anterior or posterior group (AOP grop), 8 in the anterior and posterior group (AAP group)) were further reviewed to better characterize the sample. Only one of 105 (0.9%) patients developed acute complication, which was post-operative hemorrhage requiring immediate surgical intervention. It was resolved without any neurologic deficit or casualty. There were no hematomas, airway complications or deaths. Preliminary results of the resource utilization indicated that the average anesthesia duration for the patients receiving neurosurgical intervention for DSC was 4.88 ?b 1.78 hr, average operation duration, average ICU stay, average length of hospital stay, average ICU cost, average cost of hospital stay, and average reimbursement cost were 3.87 ?b 1.67 hr, 1.20 ?b 0.47 day, 8.94 ?b 4.70 day, 8,534 ?b 3,330 NTD, 11,765 ?b 7,237 NTD, and 104,777 ?b 33,071 NTD, respectively. The average length of hospital stay (8.48 ?b 4.44 vs. 14.50 ?b 4.54 day, p
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