Imagama Shiro, Kawakami Noriaki, Tsuji Taichi, Ohara Tetsuya, Matsubara Yuji, Kanemura Tokumi, Goto Manabu, Katayama Yoshito, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
J Orthop Sci. 2011 Sep;16(5):510-5. doi: 10.1007/s00776-011-0123-6. Epub 2011 Jul 2.
Lumbar surgery and associated complications are increasing as society is aging. However, definitions of complications after lumbar surgery have not been established and previous reports have varied in the definition of, and focus on, intraoperative or major postoperative complications. We analyzed the frequency and severity of perioperative complications and all minor adverse events in lumbar surgery at a single center.
We retrospectively reviewed all lumbar surgery, including decompression surgery with or without fusion, at Meijo Hospital over a 10-year period. Perioperative complications and all surgery-related adverse events until 1 month postoperatively were reviewed for 1012 operations on 918 patients (average age 54 years old). The incidence of intraoperative complications was compared between junior (<10 years experience of spine surgery) and senior (≥10 years experience) surgeons.
Perioperative complications and adverse events occurred in 159 operations (15.7%) on 127 patients (13.8%). There were a variety of perioperative adverse events, including digestive problems. Of the 159 complications and events, 24 (2.4%) were intraoperative and 135 (13.3%) were postoperative. Incidence of intraoperative complications was not significantly higher for junior surgeons; however, the operations performed by senior surgeons were significantly more invasive. Complications were more frequent in elderly patients (p < 0.01) and in operations that were longer (p < 0.0001), had greater estimated blood loss (p < 0.0001), and involved use of spinal instrumentation (p < 0.0001). Psychotic symptoms occurred significantly more often in older patients (p < 0.001).
The absence of a relationship between the experience of the surgeon and incidence of intraoperative complications may be because of the greater effect of invasive surgery. Although age and invasiveness were associated with more perioperative adverse events, we do not conclude that major surgery should be avoided for elderly patients. In contrast, careful focus on the surgical indication and procedure is required for these patients.
随着社会老龄化，腰椎手术及相关并发症的发生率正在上升。然而，腰椎手术后并发症的定义尚未确立，以往的报告在术中或术后主要并发症的定义和关注点上存在差异。我们分析了单中心腰椎手术围手术期并发症及所有轻微不良事件的发生频率和严重程度。
我们回顾性分析了名城医院10年间所有的腰椎手术，包括有或无融合的减压手术。对918例患者（平均年龄54岁）的1012例手术进行了围手术期并发症及术后1个月内所有与手术相关的不良事件的评估。比较了初级（脊柱手术经验<10年）和高级（脊柱手术经验≥10年）外科医生术中并发症的发生率。
127例患者（13.8%）的159例手术（15.7%）发生了围手术期并发症和不良事件。围手术期不良事件种类繁多，包括消化系统问题。在这159例并发症和事件中，24例（2.4%）为术中并发症，135例（13.3%）为术后并发症。初级外科医生术中并发症的发生率并未显著更高；然而，高级外科医生进行的手术侵袭性明显更大。老年患者并发症更常见（p<0.01），手术时间更长（p<0.0001）、估计失血量更大（p<0.0001）以及使用脊柱内固定器械的手术中并发症更常见（p<0.0001）。老年患者精神症状的发生率明显更高（p<0.001）。
外科医生的经验与术中并发症发生率之间不存在关联，可能是因为侵袭性手术的影响更大。虽然年龄和侵袭性与更多围手术期不良事件相关，但我们并不认为老年患者应避免进行大型手术。相反，对于这些患者需要仔细关注手术指征和手术操作。
