合并症对退行性腰椎疾病脊柱手术风险和获益的影响。
The influence of comorbidity on the risks and benefits of spine surgery for degenerative lumbar disorders.
机构信息
Spine Center Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland,
出版信息
Eur Spine J. 2014 Apr;23 Suppl 1(Suppl 1):S66-71. doi: 10.1007/s00586-014-3189-y. Epub 2014 Jan 24.
PURPOSE
The ageing of the population will see a growing number of patients presenting for spine surgery with appropriate indications but numerous medical comorbidities. This complicates decision-making, requiring that the likely benefit of surgery (outcome) be carefully weighed up against the potential risk (complications). We assessed the influence of comorbidity on the risks and benefits of spine surgery.
METHODS
3,549/4,053 patients with degenerative lumbar disorders, undergoing surgery with the goal of pain relief, completed the multidimensional Core Outcome Measures Index (COMI; scored 0-10) before and 12 months after surgery. At 12 months postoperatively, they also rated the global treatment outcome and their satisfaction with care. Using the Eurospine Spine Tango Registry, surgeons documented surgical details, American Society of Anesthesiologists comorbidity (ASA) grades and perioperative surgical and general complications.
RESULTS
29.0% patients were rated as ASA1 (normal healthy), 45.7% as ASA2 (mild/moderate systemic disease), 24.9% as ASA3 (severe), and just 0.4% as ASA4 (life-threatening). In going from ASA1 to ASA3 (ASA4 group too small), surgical complications increased significantly from 5.0 to 14.5% and general complications increased from 2.9 to 15.7%; 12-month outcomes showed a corresponding decline, with a good global outcome being reported by 79% ASA1 patients, 76% ASA2, and 68% ASA3. Satisfaction with treatment was 87, 85, and 79%, respectively, and reduction in COMI was 4.2 ± 2.9, 3.7 ± 3.0, and 3.4 ± 3.0 points, respectively. Multiple regression analysis revealed a significant (p < 0.0001) independent effect of ASA grade on both complications and outcome.
CONCLUSION
The negative impact of comorbidity on the outcome of spine surgery has not been well investigated/quantified to date. The ASA grade may be helpful in producing algorithms for decision-making and preoperative counselling regarding the corresponding risks and benefits of surgery.
目的
随着人口老龄化，越来越多有适应证的患者将接受脊柱手术，但他们往往合并多种内科疾病。这使得决策变得复杂，需要仔细权衡手术的预期获益（结局）与潜在风险（并发症）。我们评估了内科合并症对脊柱手术风险和获益的影响。
方法
3549/4053 例退行性腰椎疾病患者，为缓解疼痛接受手术治疗，在术前和术后 12 个月时使用多维核心结局测量指标（COMI；评分 0-10）进行评估。术后 12 个月时，他们还对整体治疗结局和对治疗的满意度进行评分。研究人员使用 Eurospine Spine Tango 登记处，记录外科医生的手术细节、美国麻醉医师协会（ASA）合并症分级和围手术期手术及一般并发症。
结果
29.0%的患者被评定为 ASA1（健康），45.7%为 ASA2（轻度/中度系统性疾病），24.9%为 ASA3（重度），仅有 0.4%为 ASA4（危及生命）。从 ASA1 到 ASA3（ASA4 组太小），手术并发症从 5.0%显著增加至 14.5%，一般并发症从 2.9%增加至 15.7%；12 个月时的结局也相应下降，79%的 ASA1 患者、76%的 ASA2 患者和 68%的 ASA3 患者报告了良好的总体结局。治疗满意度分别为 87%、85%和 79%，COMI 减少分别为 4.2±2.9、3.7±3.0 和 3.4±3.0 分。多元回归分析显示，ASA 分级对并发症和结局有显著的（p<0.0001）独立影响。
结论
目前，内科合并症对脊柱手术结局的负面影响尚未得到充分研究/量化。ASA 分级可能有助于制定决策算法，并对手术的相应风险和获益进行术前咨询。
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