Comparative analysis of patient demographics, perioperative outcomes, and adverse events after lumbar spinal fusion between urban and rural hospitals: an analysis of the National Inpatient Sample (NIS) database.
Clin Neurol Neurosurg
; 243: 108375, 2024 Aug.
Article
en En
| MEDLINE
| ID: mdl-38901378
ABSTRACT
OBJECTIVE:
Rural location of a patient's primary residence has been associated with worse clinical and surgical outcomes due to limited resource availability in these parts of the US. However, there is a paucity of literature investigating the effect that a rural hospital location may have on these outcomes specific to lumbar spine fusions.METHODS:
Using the National Inpatient Sample (NIS) database, we identified all patients who underwent primary lumbar spinal fusion in the years between 2009 and 2020. Patients were separated according to whether the operative hospital was considered rural or urban. Univariable and multivariable regression models were used for data analysis.RESULTS:
Of 2,863,816 patients identified, 120,298 (4.2â¯%) had their operation at a rural hospital, with the remaining in an urban hospital. Patients in the urban cohort were younger (Pâ¯< .001), more likely to have private insurance (39.81â¯% vs 31.95â¯%, Pâ¯< .001), and fewer of them were in the first (22.52â¯% vs 43.00â¯%, Pâ¯< .001) and second (25.96â¯% vs 38.90â¯%, Pâ¯< .001) quartiles of median household income compared to the rural cohort. The urban cohort had significantly increased rates of respiratory (4.49â¯% vs 3.37â¯%), urinary (5.25â¯% vs 4.15â¯%), infectious (0.49â¯% vs 0.32â¯%), venous thrombotic (0.57â¯% vs 0.24â¯%, Pâ¯< .001), and neurological (0.79â¯% vs 0.36â¯%) (all Pâ¯< .001) perioperative complications. On multivariable analysis, the urban cohort had significantly increased odds of the same perioperative complications respiratory (odds ratio[OR]â¯=â¯1.48; 95â¯% confidence interval [CI], 1.26-1.74), urinary (ORâ¯=â¯1.34; 95â¯%CI, 1.20-1.50), infection (ORâ¯=â¯1.63; 95â¯%CI, 1.23-2.17), venous thrombotic (ORâ¯=â¯1.79; 95â¯%CI, 1.32-2.41), neurological injury (ORâ¯=â¯1.92; 95â¯%CI, 1.46-2.53), and localized infection (ORâ¯=â¯1.65; 95â¯%CI, 1.25-2.17) (all Pâ¯< .001).CONCLUSIONS:
Patients undergoing lumbar fusions experience significantly different outcomes based on the rural or urban location of the operative hospital.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
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Fusión Vertebral
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Hospitales Rurales
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Hospitales Urbanos
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Bases de Datos Factuales
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Vértebras Lumbares
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Clin Neurol Neurosurg
Año:
2024
Tipo del documento:
Article