Stanford University School of Medicine, Stanford, CA 94304, USA.
Spine (Phila Pa 1976). 2011 Sep 1;36(19):E1274-80. doi: 10.1097/BRS.0b013e318206cda3.
Retrospective chart review.
To identify predictors of 30-day complications after the surgical treatment of spinal metastasis.
Surgical treatment of spinal metastasis is considered palliative with the aim of reducing or delaying neurologic deficit. Postoperative complication rates as high as 39% have been reported in the literature. Complications may impact patient quality of life and increase costs; therefore, an understanding of which preoperative variables best predict 30-day complications will help risk-stratify patients and guide therapeutic decision making and informed consent.
We retrospectively reviewed 200 cases of spinal metastasis surgically treated at Stanford Hospital between 1999 and 2009. Multiple logistic regression was performed to determine which preoperative variables were independent predictors of 30-day complications.
Sixty-eight patients (34%) experienced one or more complications within 30 days of surgery. The most common complications were respiratory failure, venous thromboembolism, and pneumonia. On multivariate analysis, Charlson Comorbidity Index score was the most significant predictor of 30-day complications. Patients with a Charlson score of two or greater had over five times the odds of a 30-day complication as patients with a score of zero or one.
After adjusting for demographic, oncologic, neurologic, operative, and health factors, Charlson score was the most robust predictor of 30-day complications. A Charlson score of two or greater should be considered a surgical risk factor for 30-day complications, and should be used to risk-stratify surgical candidates. If complications are anticipated, medical staff can prepare in advance, for instance, scheduling aggressive ICU care to monitor for and treat complications. Finally, Charlson score should be controlled for in future spinal metastasis outcomes studies and compared to other comorbidity assessment tools.
回顾性病历回顾。
确定脊柱转移瘤手术治疗后 30 天并发症的预测因素。
脊柱转移瘤的手术治疗被认为是姑息性的，目的是减少或延迟神经功能缺损。文献报道术后并发症发生率高达 39%。并发症可能会影响患者的生活质量并增加成本；因此，了解哪些术前变量能最好地预测 30 天内的并发症将有助于对患者进行风险分层，并指导治疗决策和知情同意。
我们回顾性分析了 1999 年至 2009 年斯坦福医院 200 例脊柱转移瘤患者的病例。采用多变量逻辑回归分析确定哪些术前变量是 30 天内并发症的独立预测因素。
68 例（34%）患者在手术后 30 天内发生 1 种或多种并发症。最常见的并发症是呼吸衰竭、静脉血栓栓塞和肺炎。多变量分析显示，Charlson 合并症指数评分是 30 天内并发症的最显著预测因素。Charlson 评分≥2 的患者发生 30 天内并发症的几率是评分 0-1 的患者的 5 倍以上。
在调整了人口统计学、肿瘤学、神经病学、手术和健康因素后，Charlson 评分是 30 天内并发症的最强预测因素。Charlson 评分≥2 应被视为 30 天内并发症的手术危险因素，并应用于对手术候选者进行风险分层。如果预计会出现并发症，医务人员可以提前做好准备，例如，安排强化 ICU 护理，以监测和治疗并发症。最后，Charlson 评分应在未来的脊柱转移瘤预后研究中进行控制，并与其他合并症评估工具进行比较。
