Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA.
Spine (Phila Pa 1976). 2011 Oct 15;36(22):1867-77. doi: 10.1097/BRS.0b013e3181c7decc.
Analysis of population-based national hospital discharge data collected for the National Inpatient Sample.
To examine demographics of patients undergoing primary anterior spine fusion (ASF), posterior spine fusion (PSF), and anterior/posterior spine fusion (APSF) of the noncervical spine, assess the incidence of perioperative morbidity and mortality, and determine independent risk factors for in-hospital death.
The utilization of surgical fusion has been increasing dramatically. Despite this trend, a paucity of literature addressing perioperative outcomes exists.
Data collected for each year between 1998 and 2006 for the National Inpatient Sample were analyzed. Discharges with a procedure code for primary noncervical spine fusion were included in the sample. The prevalence of patient as well as health care system-related demographics were evaluated by procedure type (ASF, PSF, and APSF). Frequencies of procedure-related complications and in-hospital mortality were analyzed. Independent predictors for in-hospital mortality were determined.
We identified 261,256 entries representing an estimated 1,273,228 hospitalizations for primary spine fusion. Patients undergoing ASF and APSF were significantly younger (44.8 ± 0.08 and 44.22 ± 0.11 years) and had lower average comorbidity indeces (0.30 ± 0.002 and 0.31 ± 0.004) than those undergoing PSF (52.12 ± 0.04 years and 0.41 ± 0.002) (P < 0.0001). The incidence of procedure-related complications was 18.68% among ASF, 15.72% in PSF, and 23.81% in APSF patients (P < 0.0001). In-hospital mortality rates after APSF were approximately twice those of PSF (0.51 ± 0.038 vs. 0.26 ± 0.012) (P < 0.0001). Adjusted risk factors for in-hospital mortality included the following: APSF and ASF compared to PSF, male gender, increasing age, and increasing comorbidity burden. Several comorbidities and complications independently increased the risk for perioperative death, as did underlying spinal pathology.
Despite being performed in generally younger and healthier patients, APSF and ASF are associated with increased morbidity and mortality. Our findings can be used for the purposes of risk stratification, accurate patient consultation, and hypothesis formation for future research.
对国家住院患者样本中收集的基于人群的国家医院出院数据进行分析。
分析行单纯前路脊柱融合术（ASF）、单纯后路脊柱融合术（PSF）和前后路脊柱融合术（APSF）的非颈椎脊柱患者的人口统计学特征，评估围手术期发病率和死亡率，并确定院内死亡的独立危险因素。
手术融合的应用呈显著上升趋势。尽管有这种趋势，但有关围手术期结果的文献却很少。
对 1998 年至 2006 年期间国家住院患者样本中收集的数据进行分析。将主要非颈椎脊柱融合术的程序代码纳入样本。通过手术类型（ASF、PSF 和 APSF）评估患者和医疗保健系统相关的人口统计学特征的流行率。分析手术相关并发症和院内死亡率的频率。确定院内死亡率的独立预测因素。
我们确定了 261256 个条目，估计有 1273228 例患者因主要脊柱融合术住院。行 ASF 和 APSF 的患者明显更年轻（44.8±0.08 岁和 44.22±0.11 岁），平均合并症指数较低（0.30±0.002 岁和 0.31±0.004 岁），而 PSF 患者年龄较大（52.12±0.04 岁），合并症指数较高（0.41±0.002 岁）（P<0.0001）。ASF 患者手术相关并发症发生率为 18.68%，PSF 为 15.72%，APSF 为 23.81%（P<0.0001）。APSF 术后院内死亡率约为 PSF 的两倍（0.51±0.038 比 0.26±0.012）（P<0.0001）。院内死亡的调整后危险因素包括：APSF 和 ASF 与 PSF 相比、男性、年龄增长和合并症负担增加。几种合并症和并发症独立增加了围手术期死亡的风险，脊柱基础病变也是如此。
尽管 APSF 和 ASF 主要应用于更年轻和更健康的患者，但它们与发病率和死亡率增加相关。我们的发现可用于风险分层、准确的患者咨询以及未来研究的假设形成。
