颈前路融合术后吞咽困难的发生率及危险因素。
Incidence and risk factors for dysphagia after anterior cervical fusion.
机构信息
*Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; and †Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
出版信息
Spine (Phila Pa 1976). 2013 Oct 1;38(21):1820-5. doi: 10.1097/BRS.0b013e3182a3dbda.
STUDY DESIGN
Retrospective database analysis.
OBJECTIVE
To determine the national incidence, mortality, and risk factors for dysphagia associated with anterior cervical spinal fusion surgery in the United States.
SUMMARY OF BACKGROUND DATA
Dysphagia is a known complication associated with anterior cervical fusion (ACF). A population-based database was analyzed to characterize the incidence of dysphagia in terms of demographics, mortality, and risk factors associated with ACF.
METHODS
Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project were obtained from 2002 to 2009. Patients undergoing ACF for cervical myelopathy and/or radiculopathy were identified and separated into cohorts (1- to 2-level and 3+-level fusions), and incidences of dysphagia were identified. Demographics, length of stay, costs, mortality, and use of bone morphogenetic proteins (BMPs) were assessed. Statistical data were analyzed in SPSS (version 20), using the Student t test for discrete variables and the χ test for categorical data. Binomial logistic regression was used to identify independent predictors of dysphagia. A P value of less than 0.001 was used to denote significance.
RESULTS
A total of 159,590 ACF cases were identified of which 139,434 were 1- to 2-level ACF and 20,156 were 3+-level ACF. The incidence of dysphagia in the 3+-level ACF group was double that of the 1- to 2-level ACF group (44.8 vs. 22.4 per 1000; P < 0.001). Patients with dysphagia were significantly older than patients without dysphagia (P < 0.001). Dysphagia was more common in males undergoing 1- to 2-level ACF (P < 0.001). BMP was used more frequently for patients with dysphagia in the 1- to 2-level ACF group (9.4% vs. 7.2% of cases; P < 0.001). Logistic regression analysis demonstrated that independent predictors for dysphagia included age (≥65 yr), male sex, 3+-level fusion, BMP use, and preoperative patient comorbidities.
CONCLUSION
Dysphagia occurs twice as often after 3+-level ACF compared with 1- to 2-level ACF. Utilization of BMP was also linked to an increased incidence of dysphagia in the 1- to 2-level ACF group. Regardless of the number of levels fused, patients experiencing dysphagia had increased age, comorbid risk factors, hospitalizations, and costs.
LEVEL OF EVIDENCE
研究设计
回顾性数据库分析。
目的
在美国确定与前路颈椎融合术相关的吞咽困难的全国发病率、死亡率和危险因素。
背景资料概要
吞咽困难是与前路颈椎融合术（ACF）相关的已知并发症。对基于人群的数据库进行了分析，根据人口统计学、死亡率和与 ACF 相关的危险因素来描述吞咽困难的发生率。
方法
从 2002 年至 2009 年，从医疗保健成本和利用项目的全国住院患者样本中获取数据。识别出接受 ACF 治疗颈椎脊髓病和/或神经根病的患者，并将其分为队列（1-2 级和 3+级融合），并确定吞咽困难的发生率。评估了人口统计学、住院时间、费用、死亡率和骨形态发生蛋白（BMP）的使用情况。使用 SPSS（版本 20）分析统计数据，使用学生 t 检验离散变量和卡方检验分类数据。二项逻辑回归用于确定吞咽困难的独立预测因素。P 值小于 0.001 表示具有统计学意义。
结果
共确定了 159590 例 ACF 病例，其中 139434 例为 1-2 级 ACF，20156 例为 3+级 ACF。3+级 ACF 组吞咽困难的发生率是 1-2 级 ACF 组的两倍（44.8 比 22.4/1000；P<0.001）。有吞咽困难的患者明显比没有吞咽困难的患者年龄大（P<0.001）。1-2 级 ACF 中，男性吞咽困难更为常见（P<0.001）。1-2 级 ACF 中，使用 BMP 的患者吞咽困难更为常见（9.4%比 7.2%的病例；P<0.001）。逻辑回归分析表明，吞咽困难的独立预测因素包括年龄（≥65 岁）、男性、3+级融合、BMP 使用和术前患者合并症。
结论
与 1-2 级 ACF 相比，3+级 ACF 后吞咽困难的发生率增加了一倍。1-2 级 ACF 中，使用 BMP 也与吞咽困难发生率增加有关。无论融合的水平如何，经历吞咽困难的患者年龄更大，合并症风险因素、住院时间和费用也更高。
证据水平
3 级。
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