...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Neurosurgical focus >Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002?
【24h】

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002?

机译：危险因素与成人良性硬脑膜内脊柱肿瘤切除术后不良预后的关系以及医院规模对预后的影响：使用美国国家住院样本对2002年全美774家医院的18 297名患者进行分析（2002年？

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

OBJECT Because of the limited data available regarding the associations between risk factors and the effect of hospital case volume on outcomes after resection of intradural spine tumors, the authors attempted to identify these associations by using a large population-based database. METHODS Using the National Inpatient Sample database, the authors performed a retrospective cohort study that involved patients who underwent surgery for an intradural spinal tumor between 2002 and 2011. Using national estimates, they identified associations of patient demographics, medical comorbidities, and hospital characteristics with inpatient postoperative outcomes. In addition, the effect of hospital volume on unfavorable outcomes was investigated. Hospitals that performed fewer than 14 resections in adult patients with an intradural spine tumor between 2002 and 2011 were labeled as low-volume centers, whereas those that performed 14 or more operations in that period were classified as high-volume centers (HVCs). These cutoffs were based on the median number of resections performed by hospitals registered in the National Inpatient Sample during the study period. RESULTS Overall, 18,297 patients across 774 hospitals in the United States underwent surgery for an intradural spine tumor. The mean age of the cohort was 56.53 ± 16.28 years, and 63% were female. The inpatient postoperative risks included mortality (0.3%), discharge to rehabilitation (28.8%), prolonged length of stay (> 75th percentile) (20.0%), high-end hospital charges (> 75th percentile) (24.9%), wound complications (1.2%), cardiac complications (0.6%), deep vein thrombosis (1.4%), pulmonary embolism (2.1%), and neurological complications, including durai tears (2.4%). Undergoing surgery at an HVC was significantly associated with a decreased chance of inpatient mortality (OR 0.39; 95% CI 0.16?0.98), unfavorable discharge (OR 0.86; 95% CI 0.76?0.98), prolonged length of stay (OR 0.69; 95% CI 0.62?0.77), high-end hospital charges (OR 0.67; 95% CI 0.60?0.74), neurological complications (OR 0.34; 95% CI 0.26?0.44), deep vein thrombosis (OR 0.65; 95% CI 0.45?0.94), wound complications (OR 0.59; 95% CI 0.41?0.86), and gastrointestinal complications (OR 0.65; 95% CI 0.46?0.92). CONCLUSIONS The results of this study provide individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics and shows a decreased risk for most unfavorable outcomes for those who underwent surgery at an HVC. These findings could be used as a tool for risk stratification, directing presurgical evaluation, assisting with surgical decision making, and strengthening referral systems for complex cases.
机译：目的由于在硬膜内脊柱肿瘤切除术后危险因素与医院病例数量对结局的影响之间的关联性数据有限，因此作者试图通过使用基于人群的大型数据库来识别这些关联性。方法使用美国国家住院患者样本数据库，进行一项回顾性队列研究，该研究纳入了2002年至2011年间接受硬膜内脊柱肿瘤手术的患者。根据国家估计，他们确定了患者的人口统计学特征，合并症，医院特点与住院患者之间的关系。术后结果。此外，还研究了医院数量对不良结局的影响。在2002年至2011年之间，对患有硬膜内脊柱肿瘤的成年患者进行少于14例切除的医院被标记为小容量中心，而在此期间进行14次或以上手术的那些医院被分类为大容量中心（HVC）。这些临界值是基于研究期间在“国家住院样本”中注册的医院进行的切除术的中位数。结果总体上，美国774家医院的18297名患者接受了硬膜内脊柱肿瘤手术。该队列的平均年龄为56.53±16.28岁，女性为63％。住院术后风险包括死亡率（0.3％），出院康复（28.8％），长期住院（> 75％）（20.0％），高端医院收费（> 75％）（24.9％），伤口并发症（1.2％），心脏并发症（0.6％），深静脉血栓形成（1.4％），肺栓塞（2.1％）和神经系统并发症，包括杜莱泪（2.4％）。在HVC进行手术与住院死亡率降低（OR 0.39; 95％CI 0.16？0.98），出院不良（OR 0.86; 95％CI 0.76？0.98），住院时间延长（OR 0.69; 95）显着相关％CI 0.62？0.77），高端医院收费（OR 0.67; 95％CI 0.60？0.74），神经系统并发症（OR 0.34; 95％CI 0.26？0.44），深静脉血栓形成（OR 0.65; 95％CI 0.45？ 0.94），伤口并发症（OR 0.59; 95％CI 0.41〜0.86）和胃肠道并发症（OR 0.65; 95％CI 0.46〜0.92）。结论这项研究的结果根据患者的人口统计和合并症以及医院的特点提供了术后并发症风险的个性化估计，并且显示了接受HVC手术的患者发生最不利结局的风险降低了。这些发现可以用作风险分层，指导手术前评估，协助手术决策和加强复杂病例转诊系统的工具。

著录项

相似文献

  • 外文文献
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号