Shen Yang, Silverstein Jonathan C, Roth Steven
Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
J Neurosurg Anesthesiol. 2009 Jan;21(1):21-30. doi: 10.1097/ANA.0b013e31818b47e9.
Spinal fusion surgery has increased dramatically and patients presenting for surgery are often more medically challenging. We hypothesized that advanced age and coexisting morbidities have increased in the population undergoing spinal fusion and are associated with greater risks for immediate complications and mortality. The Nationwide Inpatient Sample was retrospectively reviewed for discharges after a principal procedure code for elective spinal fusion. Total records meeting study inclusion criteria were 254,640. Coexisting morbidities were tabulated using Elixhauser comorbidities and the Charlson comorbidity index. Logistic regression identified risk factors associated with in-hospital mortality and early complications. The largest increase in spinal fusion surgery was in patients >65 years. Overall, those with at least 1 comorbidity increased (49% to 62%; P=0.002), as did mean Charlson index (0.146 to 0.202; P<0.001). In-hospital mortality was 0.13%, but 0.29%, and 0.64% for patients of 65 to 74, and those >or=75 years, respectively. Adjusted odds ratios for complications in 65-year to 74-year olds versus <65 years was 1.78 (95% confidence interval, 1.71-1.84; P<0.001), and for mortality 3.81 (95% confidence interval, 2.62-5.55; P<0.001); risks increased with the number of coexisting morbidities. Congestive heart failure, chronic pulmonary disease, coagulopathy, metastatic cancer, renal failure, and weight loss significantly correlated with in-hospital mortality, whereas hypertension or hypothyroidism had, unexpectedly, the opposite effect. Although it is known for some other forms of complex surgery, we showed that elderly and medically complex spinal fusion patients were at increased risk for in-hospital mortality and early complications. The majority of complications were operative, pulmonary, cardiovascular, or genito-urinary. Patient risk correlated with the number and nature of coexisting morbidities.
脊柱融合手术的数量急剧增加，接受该手术的患者在医学方面往往更具挑战性。我们推测，接受脊柱融合手术的人群中高龄和并存疾病的情况有所增加，且与近期并发症和死亡率的更高风险相关。我们对全国住院患者样本进行了回顾性研究，纳入了择期脊柱融合手术主要操作编码后的出院病例。符合研究纳入标准的总记录数为254,640例。使用埃利克斯豪泽共病指数和查尔森共病指数对并存疾病进行列表统计。逻辑回归分析确定了与住院死亡率和早期并发症相关的危险因素。脊柱融合手术增加最多的是65岁以上的患者。总体而言至少有一种并存疾病的患者比例从49%增至62%（P = 0.002），查尔森指数平均值也从0.146增至0.202（P < 0.001）。住院死亡率为0.13%，但65至74岁患者的死亡率为0.29%，75岁及以上患者的死亡率为0.64%。65至74岁患者与65岁以下患者相比，并发症的校正比值比为1.78（95%置信区间为1.71 - 1.84；P < 0.001），死亡率的校正比值比为3.81（95%置信区间为2.62 - 5.55；P < 0.001）；风险随着并存疾病数量的增加而升高。充血性心力衰竭、慢性肺病、凝血障碍、转移性癌症、肾衰竭和体重减轻与住院死亡率显著相关，而高血压或甲状腺功能减退症却出人意料地产生相反的影响。尽管在其他一些复杂手术形式中已有报道，但我们发现老年和医学情况复杂的脊柱融合手术患者住院死亡率和早期并发症的风险增加。大多数并发症为手术相关、肺部、心血管或泌尿生殖系统并发症。患者风险与并存疾病的数量和性质相关。
