在选择性腰部融合后,有限的初级保健准入和更高的再入院和再手术之间的关联
Yifei Sun1, Sasha Howell2, Nicholas M B Laskay2
11Heersink School of Medicine, University of Alabama at Birmingham.
Journal of neurosurgery. Spine
|October 17, 2025
概括
缺乏获得初级医疗保健的机会增加了腰椎脊髓融合患者的风险. 医疗服务不足地区的患者面临更高的再入院和再手术率,突出需要更好的手术前风险评估.
科学领域:
- 神经外科 神经外科
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 腰椎脊柱融合是退行性脊柱疾病的常见程序.
- 社会经济地位影响腰部融合结果,但机制尚不清楚.
- 获得初级医疗保健的限制可能会导致手术结果的差异.
研究的目的:
- 调查低初级医疗保健和选择性腰部融合后并发症之间的关联.
- 评估在医疗服务不足地区 (MUAs) 居住对再入院和重新手术率的影响.
主要方法:
- 对1567个腰椎融合手术 (2011-2023) 的回顾性分析.
- 对患者地址进行地理空间分析,以确定MUA状态.
- 多变量和匹配分析来评估MUA居住对结果的影响.
主要成果:
- 患者在MUAs有显著更高的30天 (OR1.86) 和90天 (OR1.84) 重新入院的几率.
- 在匹配后,MUA居民由于并发症增加了30天 (13%对4.6%) 和90天 (15%对7.4%) 的再入院.
- 在30天内 (9.1%对3.7%) 和90天内 (12%对5.1%) 的MUA居民的重新操作率也更高.
结论:
- 有限的初级保健准入与腰椎融合后的并发症和再入院增加有关.
- 医疗服务不足的地区地位是手术前风险分层的潜在指标.
- 解决获得初级保健的差异可能会减少计划外的再入院,并改善外科手术的结果.
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