*Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, NY; and †Department of Population Health, NYU School of Medicine, Biostatistics, New York, NY.
Spine (Phila Pa 1976). 2014 Mar 15;39(6):482-90. doi: 10.1097/BRS.0000000000000170.
Retrospective analysis.
To determine patient demographics, incidence of comorbidities, and procedure-related complications and identify risk factors associated with morbidity and mortality after spinal surgery for cauda equina syndrome (CES).
To our knowledge, no study has provided nationwide estimates of patient characteristics and procedure-related complication rates after spinal surgery for CES relative to an unaffected population.
Nationwide Inpatient Sample data collected between 2001 and 2010 were analyzed. Discharges with procedural codes for lumbar spinal fusion, decompression, or discectomy were included. The CES cohort included diagnoses of CES, and the unaffected cohort included lumbar spinal pathology diagnoses. Patient demographics, incidence of comorbidities and procedure-related complications, and risk factors associated with morbidity and mortality were compared.
Discharges for 11,207 CES and 689,799 unaffected patients were identified. Differences between cohorts were found for demographic and hospital data. Average comorbidity indices for the CES cohort were found to be increased (0.23 vs. 0.13, P < 0.0001), as well as the incidence of total procedure-related complications (18.63% vs. 13.12%, P < 0.0001). In-hospital mortality rate was significantly increased for the CES cohort (0.30% vs. 0.08%, P < 0.0001). A number of comorbidities associated with additional risk for morbidity and mortality among the CES cohort were identified.
Relative to an unaffected population undergoing similar treatment, patients with CES were more likely to have increased associated comorbidities on presentation, as well as increased complication rates with a prolonged hospital course postoperatively. CES was found to carry an increased incidence of procedure-related complications as well as in-hospital mortality. A number of comorbidities associated with additional risk for morbidity and mortality among the CES cohort were identified. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality as well as direct future research to improve patient outcomes.
回顾性分析。
确定患者的人口统计学特征、合并症的发生率以及与脊柱手术后马尾综合征（CES）相关的发病率和死亡率相关的手术相关并发症，并确定相关的发病和死亡风险因素。
据我们所知，没有研究提供过与未受影响人群相比，脊柱手术后 CES 患者的特征和与手术相关的并发症发生率的全国性估计。
对 2001 年至 2010 年间收集的全国性住院患者样本数据进行了分析。纳入了腰椎脊柱融合术、减压术或椎间盘切除术的手术编码的出院患者。CES 队列包括 CES 诊断，未受影响的队列包括腰椎脊柱病理诊断。比较了患者的人口统计学特征、合并症和与手术相关的并发症发生率，以及与发病率和死亡率相关的风险因素。
确定了 11207 例 CES 和 689799 例未受影响患者的出院记录。在人口统计学和医院数据方面，两个队列之间存在差异。CES 队列的平均合并症指数较高（0.23 比 0.13，P<0.0001），总手术相关并发症的发生率也较高（18.63%比 13.12%，P<0.0001）。CES 队列的住院死亡率显著增加（0.30%比 0.08%，P<0.0001）。确定了 CES 队列中与发病率和死亡率相关的多种合并症。
与接受类似治疗的未受影响人群相比，CES 患者在就诊时更有可能出现合并症增加，以及术后住院时间延长时并发症发生率增加。CES 与手术相关并发症的发生率增加以及住院期间的死亡率增加有关。确定了 CES 队列中与发病率和死亡率相关的多种合并症。本研究为外科医生提供了有用的临床数据，以教育有发病率和死亡率风险的患者，并指导未来的研究以改善患者的预后。
3 级。
