腰椎融合术后患者门诊复诊的临床特征及其影响因素分析

Analysis of clinical characteristics and influencing factors of outpatient follow-up visits in patients after lumbar fusion surgery

中文关键词:  腰椎融合术  门诊复诊  影响因素

英文关键词:Lumbar fusion surgery  Outpatient follow-up  Influencing factors

中文摘要:

  【摘要】 目的：探讨腰椎融合术后患者门诊复诊的临床特征及其影响因素。方法：回顾性分析我院2019年1月～2023年12月因腰椎退变性疾病行腰椎融合手术患者的病历资料。所有患者出院时进行宣教，嘱术后1个月、3个月、6个月、12个月返院复诊，以后每年复诊1次。收集患者住院期间的一般临床资料、手术相关资料、住院时间及门诊复诊时间等信息，根据患者术后是否返院复诊进行分组，先行单因素logistic回归分析，观察性别、年龄、居住地区、费用类别、疾病种类、住院时间、住院费用、手术入路、术后并发症、出院时日常生活活动能力（activities of daily living，ADL）评分与返院复诊的相关性，并对P＜0.2的变量行多因素logistic回归分析术后未复诊的影响因素。进一步将复诊患者分为长期复诊组（复诊时间≥12个月）和短期复诊组（复诊时间＜12个月），并对患者各时间点复诊情况及是否长期复诊进行亚组分析。结果：共有5520例患者因腰椎退变性疾病行腰椎融合手术，4198例术后返院复诊，复诊率76.1%，其中复诊时间≥12个月的有1213例，占比22.0%。多因素logistic回归分析表明男性、年龄大、住院时间长为术后复诊的阻碍因素，职工医保、本科及以上文化、腰椎管狭窄及腰椎滑脱、前路手术是术后复诊的促进因素。亚组分析中多因素logistic回归显示男性、年龄大患者在各时间节点均为复诊的阻碍因素，职工医保则为复诊的促进因素。疾病种类方面，腰椎管狭窄在术后1个月、6个月为复诊的促进因素，腰椎滑脱和盘源性腰痛为术后6个月复诊的促进因素。文化程度上，本科及以上学历在术后12个月复诊及长期复诊时表现为促进因素。手术入路分析中，前路手术在术后1个月复诊时为阻碍因素，但在术后12个月复诊则变为促进因素。此外，住院时间长是术后1个月复诊的阻碍因素，市内患者是术后12个月复诊的阻碍因素，住院费用高是长期复诊的促进因素。结论：男性、年龄大患者在术后各时间点均为门诊复诊的阻碍因素，职工医保则为促进因素，需根据不同阶段门诊复诊影响因素制定针对性随访策略。

英文摘要:

  【Abstract】 Objectives: To explore the clinical characteristics and influencing factors of outpatient follow-up visits for patients after lumbar fusion surgery. Methods: A retrospective analysis was conducted on the case data of patients who underwent lumbar fusion surgery due to lumbar degenerative diseases at our hospital from January 2019 to December 2023. All patients were educated upon discharge and were instructed to return to the hospital for follow-up visits at 1 month, 3 months, 6 months and 12 months after operation, and to have a follow-up visit once a year thereafter. The general clinical data, surgery-related data, length of hospital stay and outpatient follow-up time of the patients were collected. The patients were grouped according to whether they returned to the hospital for follow-up after operation. Univariate logistic regression analysis was conducted first to observe the correlations between gender, age, residential area, expense category, disease type, length of hospital stay, hospitalization expense, surgical approach, postoperative complications, ADL score at discharge and return to the hospital for follow-up visit. Multivariate logistic regression analysis was conducted on the influencing factors of non-follow-up visit after surgery for variables with P<0.2. Further, the follow-up patients were divided into a long-term follow-up group(follow-up time≥12 months) and a short-term follow-up group(follow-up time<12 months), and subgroup analyses were conducted on the follow-up conditions of patients at each time point and whether they were long-term follow-up. Results: A total of 5,520 patients underwent lumbar fusion surgery due to lumbar degenerative diseases. Among them, 4,198 patients returned to the hospital for follow-up after operation, with a follow-up rate of 76.1%. Among them, 1,213 patients had a follow-up time of ≥12 months, accounting for 22.0%. Multivariate logistic regression analysis indicated that male, older age, and long hospital stay were the hindering factors for postoperative follow-up visits. Employee medical insurance, having a bachelor′s degree or above, lumbar spinal stenosis and lumbar spondylolisthesis, and anterior surgery were the promoting factors for postoperative follow-up visits. In the subgroup analysis, multivariate logistic regression showed that male and older patients at each time point were hindering factors for follow-up visits, while employee medical insurance was a promoting factor for follow-up visits. In terms of disease types, lumbar spinal stenosis was a promoting factor for follow-up visits at 1 month and 6 months after operation, and lumbar spondylolisthesis and discogenic low back pain were promoting factors for follow-up visits at 6 months after operation. In terms of educational level, having a bachelor′s degree or above was a promoting factor for follow-up visits at 12 months after operation and for long-term follow-up visits. In the surgery approach analysis, anterior surgery was a hindering factor for follow-up visits at 1 month after operation, but became a promoting factor for follow-up visits at 12 months after operation. Additionally, long hospital stay was a hindering factor for follow-up visits at 1 month after operation, living in the city was a hindering factor for follow-up visits at 12 months after operation, and high hospitalization costs were a promoting factor for long-term follow-up visits. Conclusions: Male and older age are barriers to outpatient follow-up at all postoperative time points, while employee medical insurance is a facilitating factor. Targeted follow-up strategies should be developed based on the characteristics of outpatient visits at different stages for patients.