颈椎手术后医疗并发症的风险因素：582 例患者的多变量分析。
Risk factors for medical complication after cervical spine surgery: a multivariate analysis of 582 patients.
机构信息
Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA 98195, USA.
出版信息
Spine (Phila Pa 1976). 2013 Feb 1;38(3):223-8. doi: 10.1097/BRS.0b013e318268ffc9.
STUDY DESIGN
Multivariate analysis of prospectively collected registry data.
OBJECTIVE
Using multivariate analysis to determine significant risk factors for medical complication after cervical spine surgery.
SUMMARY OF BACKGROUND DATA
Several studies have examined the occurrence of medical complication after spine surgery. However, many of these studies have been done using large national databases. While 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.
METHODS
The Spine End Results Registry (2003-2004) is a repository of prospectively collected data on all patients who underwent spine surgery at our 2 institutions. Extensive demographic and medical information was prospectively recorded. Complications were defined in detail a priori and were prospectively recorded for at least 2 years after surgery. We analyzed risk factors for medical complication after lumbar spine surgery, using univariate and multivariate analyses.
RESULTS
We analyzed data from 582 patients who met our inclusion criteria. The cumulative incidences of complication after cervical spine surgery per organ system are as follows: cardiac, 8.4%; pulmonary, 13%; gastrointestinal, 3.9%; neurological, 7.4%; hematological, 10.8%; and urologic complications, 9.2%. The occurrence of cardiac or respiratory complication after cervical spine surgery was significantly associated with death within 2 years (relative risk, 4.32, 6.43, respectively). Relative risk values with 95% confidence intervals and P values are reported.
CONCLUSION
Risk factors identified in this study can be beneficial to clinicians and patients alike when considering surgical treatment of the cervical spine. Future analyses and models that predict the occurrence of medical complication after cervical spine surgery may be of further benefit for surgical decision making.
研究设计
前瞻性收集的注册数据的多变量分析。
目的
使用多变量分析确定颈椎手术后发生医疗并发症的显著危险因素。
背景数据摘要
几项研究检查了脊柱手术后发生医疗并发症的情况。然而，其中许多研究使用了大型国家数据库。虽然这些数据库可以分析数千名患者，但这些回顾性研究没有考虑到潜在的有影响的协变量。此外，这些数据库中这些回顾性数据收集的准确性也受到质疑。
方法
脊柱结果登记处（2003-2004 年）是一个存储库，包含在我们的 2 个机构接受脊柱手术的所有患者的前瞻性收集数据。前瞻性记录了广泛的人口统计学和医疗信息。并发症事先进行了详细定义，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分析了腰椎手术后发生医疗并发症的危险因素。
结果
我们分析了符合我们纳入标准的 582 名患者的数据。每个器官系统的颈椎手术后并发症的累积发生率如下：心脏，8.4%；肺部，13%；胃肠道，3.9%；神经系统，7.4%；血液学，10.8%；和泌尿系统并发症，9.2%。颈椎手术后心脏或呼吸并发症的发生与 2 年内死亡显著相关（相对风险分别为 4.32 和 6.43）。报告了相对风险值及其 95%置信区间和 P 值。
结论
本研究确定的危险因素在考虑颈椎手术治疗时对临床医生和患者都有益。未来分析和预测颈椎手术后发生医疗并发症的模型可能对手术决策有进一步的帮助。
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