影响腰椎后路减压融合内固定术后住院时间的多因素分析

Abstract
Figure/Table
References (0)
Related Citation (2)

Download: PDF (670 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To identify predictors of length of stay(LOS) after lumbar spine surgery.Methods Retrospective analysis was made on the clinical data of patients who were underwent open，posterior lumbar instrumented fusion with decompression by the orthopedic spine service at one institution between May 2016 and May 2017.LOS was determined from the date of surgery to the date of discharge.Predictors of LOS were investigated with a multivariate stepwise regression model，including pre-surgery factors(patient demographics，American Society of Anesthesiologists score and major medical comorbidities including diabetes，hypertension，pulmonary disease，heart disease or renal insufficiency) and perioperative factors(estimated blood loss，blood transfusion，fluids administered，surgery time，the methods of decompression，number of levels fused，drainage duration，blood transfusion after surgery，postoperative drainage volume and complications).Results A total of 226 patients were identified.LOS ranged from 6 days to 34 days，with a median of 15 days.60(26.5％) patients were defined as the extended LOS group.Multivariate stepwise regression identified age(P＝0.010)，estimated blood loss(EBL)(P＜0.001)，and the methods of decompression(P＜0.001) as significant predictors of extended LOS.Conclusion Age，estimated blood loss and the way of decompression in the surgery are the identified variables associating with LOS.Therefore，controlling blood loss during surgery and electing appropriate techniques of posterior decompression may be beneficial to shorten the length of hospital stay after surgery.

Key words： posterior lumbar spine surgery length of stay multivariate regression age estimated blood loss method of decompression

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2018/V24/I3/195

［1］Weinstein JN，Tosteson TD，Lurie JD，et al.Surgical versus nonsurgical therapy for lumbar spinal stenosis［J］.N Engl J Med，2008，358(8)：794-810.
［2］贾桂，张晨阳，王国平，等.三种腰椎后路椎体间融合手术方法疗效比较［J］.中国矫形外科杂志，2016，24(19)：1749-1753.
［3］Cheng X，Zhang K，Sun X，et al.Clinical and radiographic outcomes of bilateral decompression via a unilateral approach with transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with stenosis［J］.The Spine Journal，2017，17(8)：1127-1133.
［4］Ren Z，Li S，Sheng L，et a.Efficacy and safety of topical use of tranexamic acid in reducing blood loss during primary lumbar spinal surgery：A retrospective case control study［J］.Spine(Phila Pa 1976)，2017，42(23)：1779-1784.
［5］闫国良，纪振钢，高浩然，等.微创经椎间孔减压腰椎融合内固定术与传统后路开放手术治疗腰椎退变性疾病的疗效比较［J］.中国脊柱脊髓杂志，2013，23(3)：244-250.
［6］Minhas SV，Chow I，Jenkins TJ，et al.Preoperative predictors of increased hospital costs in elective anterior cervical fusions：a single-institution analysis of 1，082 patients［J］.Spine J，2015，15(5)：841-848.
［7］Basques BA，Fu MC，Buerba RA，et al.Using the ACS-NSQIP to identify gactors affecting hospital length of stay after elective posterior lumbar fusion［J］.Spine，2014，39(6)：497-502.
［8］Gruskay JA，Fu M，Bohl DD，et al.Factors affecting length of stay after elective posterior lumbar spine surgery：a multivariate analysis［J］.Spine J，2015，15(6)：1188-1195.
［9］Kanaan SF，Waitman LR，Yeh H，et al.Structural equation model analysis of the length-of-hospital stay after lumbar spine surgery［J］.The Spine Journal，2015，15(4)：612-621.
［10］马驰，吴新宝，侯树勋，等.腰椎单节段固定融合术后12周不同康复模式与术后症状改善的相关性研究［J］.中国骨与关节杂志，2016，5(3)：164-169.
［11］裴倩，吴新宝，侯树勋，等.腰椎退行性疾病术后24周分级康复的疗效研究［J］.中国骨与关节杂志，2016，5(3)：170-174.
［12］刘京宇，周谋望，侯树勋，等.腰椎退行性疾病术后康复模式研究［J］.中国骨与关节杂志，2016，5(3)：183-187.
［13］Soeters PB.The enhanced recovery after surgery(ERAS) program：benefit and concerns［J］.Am J Clin Nutr，2017，106(1)：10-11.
［14］董碧蓉.老年衰弱综合征的研究进展［J］.中华保健医学杂志，2014，16(6)：417-420.
［15］Basques BA，Varthi AG，Golinvaux NS，et al.Patient characteristics associated with increased postoperative length of stay and readmission after elective laminectomy for lumbar spinal stenosis［J］.Spine，2014，39(10)：833-840.
［16］Houten JK，Nasser R.Symptomatic progression of degenerative scoliosis after decompression and limited fusion surgery for lumbar spinal stenosis［J］.J Clin Neurosci，2013，20(4)：613-615.
［17］Overdevest GM，Jacobs W，Vleggeert-Lankamp C，et al.Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis［J］.Cochrane Database Syst Rev，2015(3)：D10036.
［18］Zheng F，Cammisa FJ，Sandhu HS，et al.Factors predicting hospital stay，operative time，blood loss，and transfusion in patients undergoing revision posterior lumbar spine decompression，fusion，and segmental instrumentation［J］.Spine(Phila Pa 1976)，2002，27(8)：818-824.
［19］Goodnough LT.Blood management：transfusion medicine comes of age［J］.Lancet，2013，381(9880)：1791-1792.
［20］Mannucci P M，Levi M.Prevention and treatment of major blood loss［J］.N Engl J Med，2007，356(22)：2301-2311.