Fineberg Steven J, Oglesby Matthew, Patel Alpesh A, Singh Kern
*Rush University Medical Center, Chicago, IL †Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; and ‡Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Spine (Phila Pa 1976). 2013 Sep 1;38(19):E1189-95. doi: 10.1097/BRS.0b013e31829cc19b.
Retrospective national database analysis.
A population-based database was analyzed to characterize the incidence, mortality, and associated risk factors for aspiration pneumonia in cervical spine surgery.
Aspiration pneumonia represents a potentially fatal complication of any surgical procedure. The incidence of this complication is not well characterized after cervical spine surgery.
Data from the Nationwide Inpatient Sample was obtained from 2002-2009. Patients undergoing anterior cervical fusion, posterior cervical fusion, or posterior cervical decompression for radiculopathy and/or myelopathy were identified. Patient demographics, incidence of aspiration, costs, and mortalities 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 aspiration.
A total of 202,694 patients were identified in the Nationwide Inpatient Sample from 2002 to 2009. Of these, 166,633 were anterior cervical fusions (82.2%), 13,298 were posterior cervical fusions (6.6%), and 22,764 were posterior cervical decompressions (11.2%). The overall incidence of aspiration was 5.3 events per 1000 cases. The greatest incidence was demonstrated in posterior cervical fusion-treated patients with 13.7 per 1000 cases, followed by posterior cervical decompressions with 6.4 per 1000 and anterior cervical fusions with 4.5 per 1000. Patients affected by aspiration were significantly older, more frequently male, and had greater comorbidities than unaffected patients (P < 0.001). Patients diagnosed with aspiration demonstrated significantly greater length of stay, costs, and mortality (P < 0.001). Logistic regression analysis demonstrated independent predictors of aspiration to include advanced age (≥65 yr), male sex, congestive heart failure, coagulopathy, neuropsychiatric disorders, and weight loss (P < 0.001).
We demonstrated an overall incidence of 5.3 cases of aspiration per 1000 cervical procedures. Patients most commonly affected by aspiration were older males with greater comorbidity. Hospital courses complicated by aspiration had greater length of stay, costs, and mortality. Identification of patients with risk factors for aspiration may assist in early diagnosis and treatment to prevent further morbidity and mortality.
全国性数据库回顾性分析。
分析一个基于人群的数据库，以描述颈椎手术中误吸性肺炎的发病率、死亡率及相关危险因素。
误吸性肺炎是任何外科手术潜在的致命并发症。颈椎手术后该并发症的发病率尚无确切描述。
获取2002年至2009年全国住院患者样本的数据。确定接受前路颈椎融合术、后路颈椎融合术或因神经根病和/或脊髓病而行后路颈椎减压术的患者。评估患者的人口统计学特征、误吸发生率、费用和死亡率。对离散变量采用Student t检验，对分类数据采用χ检验进行统计分析。采用逻辑回归分析确定误吸的独立预测因素。
2002年至2009年全国住院患者样本中共识别出202,694例患者。其中，166,633例行前路颈椎融合术（82.2%），13,298例行后路颈椎融合术（6.6%），22,764例行后路颈椎减压术（11.2%）。误吸的总体发生率为每1000例中有5.3例。后路颈椎融合术治疗的患者发生率最高，为每1000例中有13.7例，其次是后路颈椎减压术，为每1000例中有6.4例，前路颈椎融合术为每1000例中有4.5例。发生误吸的患者比未发生误吸的患者年龄更大、男性更常见且合并症更多（P < 0.001）。被诊断为误吸的患者住院时间、费用和死亡率显著更高（P < 0.001）。逻辑回归分析显示误吸的独立预测因素包括高龄（≥65岁）、男性、充血性心力衰竭、凝血障碍、神经精神疾病和体重减轻（P < 0.001）。
我们证明颈椎手术中误吸的总体发生率为每1000例中有5.3例。最常发生误吸的患者是年龄较大、合并症较多的男性。因误吸而使住院过程复杂化的患者住院时间更长、费用更高且死亡率更高。识别有误吸危险因素的患者可能有助于早期诊断和治疗，以预防进一步的发病和死亡。
