Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA 98195, USA.
Spine J. 2012 Mar;12(3):197-206. doi: 10.1016/j.spinee.2011.11.008. Epub 2012 Jan 14.
Several studies have examined the occurrence of medical complication after spine surgery. However, many of these studies have been done using large national databases. Although these allow for analysis of thousands of patients, potentially influential covariates are not accounted for in these retrospective studies. Furthermore, the accuracy of these retrospective data collection in these databases has been called into question.
Using multivariate analysis on a prospectively collected data registry to determine significant risk factors for medical complication after spine surgery.
Retrospective multivariate analysis of prospectively collected registry data. The registry is a prospectively collected database of all patients who underwent spine surgery in our two institutions from January 1, 2003 to December 31, 2004.
Extensive demographic and medical information were prospectively recorded as described previously by Mirza et al. Complications were defined in detail a priori, and they were prospectively recorded for at least 2 years after surgery. We analyzed risk factors for medical complication after spine surgery using univariate and multivariate analyses.
We analyzed data from 1,591 patients who met out inclusion criteria. The cumulative incidences of complication after spine surgery per organ system are as follows: cardiac, 8.4%; pulmonary, 13%; gastrointestinal, 3.9%; neurological, 7.35%; hematological, 10.75%; and urological complications, 9.18%. The occurrence of cardiac or respiratory complication after spine surgery was significantly associated with death within 2 years (relative risk, 4.11 and 10.76, respectively). Surgical invasiveness and age were significant risk factors for complications in five of the six organ systems evaluated. Individual organ system-specific elative risk values with 95% confidence intervals and p values are listed in Tables 3 and 4.
Risk factors identified in this study can be beneficial to clinicians and patients alike when considering surgical treatment of the spine. Future analyses and models that predict the occurrence of medical complication after spine surgery may be of further benefit for surgical decision making.
已有多项研究对脊柱手术后发生医疗并发症的情况进行了调查。然而，这些研究中的许多研究都是使用大型国家数据库进行的。虽然这些研究可以对数千名患者进行分析，但在这些回顾性研究中并未考虑到潜在的有影响的协变量。此外，这些数据库中回顾性数据收集的准确性也受到了质疑。
使用前瞻性收集的数据登记处进行多变量分析，以确定脊柱手术后发生医疗并发症的显著危险因素。
前瞻性收集的数据登记处的回顾性多变量分析。该登记处是一个前瞻性收集的数据库，包含了 2003 年 1 月 1 日至 2004 年 12 月 31 日期间在我们的两个机构接受脊柱手术的所有患者的详细信息。
Mirza 等人先前已经详细描述了对广泛的人口统计学和医疗信息进行了前瞻性记录。并发症被事先详细定义，并在手术后至少 2 年进行了前瞻性记录。我们使用单变量和多变量分析来分析脊柱手术后发生医疗并发症的危险因素。
我们分析了符合纳入标准的 1591 名患者的数据。按器官系统分类，脊柱手术后并发症的累积发生率如下：心脏系统 8.4%；呼吸系统 13%；胃肠道系统 3.9%；神经系统 7.35%；血液系统 10.75%；泌尿系统 9.18%。脊柱手术后发生心脏或呼吸并发症与 2 年内死亡显著相关（相对风险分别为 4.11 和 10.76）。手术侵袭性和年龄是评估的六个器官系统中的五个系统并发症的显著危险因素。表 3 和表 4 列出了各个器官系统特定的相对风险值、95%置信区间和 p 值。
本研究确定的危险因素对考虑脊柱手术治疗的临床医生和患者都有益。未来分析和预测脊柱手术后发生医疗并发症的模型可能对手术决策制定有进一步的帮助。
