Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.
Spine (Phila Pa 1976). 2013 Jul 15;38(16):1422-9. doi: 10.1097/BRS.0b013e3182986d71.
Retrospective national database analysis.
A population-based database was analyzed to characterize the incidence, mortality, and associated risk factors for cardiac events in lumbar spine surgery.
Cardiac events are a leading cause of perioperative mortality in spinal surgery. The incidence of these complications after lumbar surgery is not well characterized on a national level.
Data from the Nationwide Inpatient Sample was obtained from 2002 to 2009. Patients undergoing lumbar decompression or lumbar fusion for degenerative etiologies were identified. Patient demographics, incidence of cardiac complications, comorbidities, and mortality were assessed. Statistical analysis was performed using Student t test for discrete variables and χ test for categorical data. Logistic regression was used to identify independent predictors for cardiac complications.
A total of 578,457 lumbar spine procedures were identified in the Nationwide Inpatient Sample from 2002 to 2009. The overall incidence of cardiac complications was 6.7 per 1000 cases. Cardiac events occurred more frequently in the lumbar fusion group, with a rate of 9.3 per 1000 cases, than in the lumbar decompression group, with a rate of 4.0 per 1000 (P < 0.0005). Patients with cardiac events were significantly older than patients without complications by 9.4 years (P < 0.0005). Patients with cardiac complications had statistically increased hospitalizations, costs, and mortality when a cardiac event was present (P < 0.0005). Logistic regression analysis demonstrated independent predictors for cardiac events to include age 65 years or older, acute blood loss anemia, and several comorbidities.
Our results demonstrated an overall incidence of 6.7 cardiac complications per 1000 lumbar spine surgical procedures from 2002 to 2009. Patients undergoing lumbar fusion were more likely to experience cardiac events than lumbar decompression patients. Cardiac events tend to occur in patients with noted risk factors and result in increased hospitalizations, costs, and mortality. On the basis of these findings, we think that patients with specified risk factors should be monitored closely and medically optimized in the perioperative period.
回顾性全国数据库分析。
通过基于人群的数据库分析，描述腰椎手术中心脏事件的发生率、死亡率和相关危险因素。
心脏事件是脊柱手术围手术期死亡的主要原因。在全国范围内，这些并发症在腰椎手术后的发生率尚不清楚。
从 2002 年至 2009 年获得全国住院患者样本的数据。确定接受腰椎减压或腰椎融合术治疗退行性病因的患者。评估患者人口统计学资料、心脏并发症发生率、合并症和死亡率。使用学生 t 检验进行离散变量分析，使用卡方检验进行分类数据分析。使用逻辑回归识别心脏并发症的独立预测因素。
在 2002 年至 2009 年的全国住院患者样本中，共确定了 578457 例腰椎手术。心脏并发症的总发生率为每 1000 例 6.7 例。心脏事件在腰椎融合组中更为常见，发生率为每 1000 例 9.3 例，而在腰椎减压组中发生率为每 1000 例 4.0 例（P <0.0005）。有心脏事件的患者比没有并发症的患者年龄大 9.4 岁（P <0.0005）。当存在心脏事件时，心脏并发症患者的住院时间、费用和死亡率均有统计学意义增加（P <0.0005）。逻辑回归分析表明，心脏事件的独立预测因素包括年龄 65 岁或以上、急性失血性贫血和几种合并症。
我们的研究结果显示，2002 年至 2009 年期间，每 1000 例腰椎手术中有 6.7 例发生心脏并发症。与腰椎减压术患者相比，行腰椎融合术的患者更有可能发生心脏事件。心脏事件往往发生在有明显危险因素的患者中，并导致住院时间、费用和死亡率增加。基于这些发现，我们认为有特定危险因素的患者应在围手术期密切监测并进行医学优化。
