髂嵴骨移植用于脊柱融合术后的短期不良事件、住院时间和再入院情况。
Short-term adverse events, length of stay, and readmission after iliac crest bone graft for spinal fusion.
作者信息
Gruskay Jordan A, Basques Bryce A, Bohl Daniel D, Webb Matthew L, Grauer Jonathan N
机构信息
From the Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
出版信息
Spine (Phila Pa 1976). 2014 Sep 15;39(20):1718-24. doi: 10.1097/BRS.0000000000000476.
STUDY DESIGN
Retrospective cohort study of 13,927 patients, 820 of whom received iliac crest bone graft (ICBG).
OBJECTIVE
To compare adverse events, length of stay (LOS), and readmission for patients receiving ICBG with those who did not using multivariate analysis to control for potentially confounding factors.
SUMMARY OF BACKGROUND DATA
The use of ICBG in spinal fusion has been associated with increased surgical time, LOS, and donor site morbidity. Development of expensive bone graft substitutes has been predicated on these issues. Data on the effect of bone graft harvest on LOS and readmission rate are sparse, and multivariate analysis has not been used to control for confounding factors.
METHODS
Prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Project 2010-2012 database were retrospectively reviewed. This includes demographics, comorbidities, surgical data, and hospital and 30-day follow-up outcomes data including adverse events, LOS, and readmission.
RESULTS
Only 5.9% of spinal fusions use ICBG. Bivariate logistic regression (used for categorical variables) found the ICBG cohort was more likely to have a postoperative blood transfusion (11.6% vs. 5.5%, P < 0.001). Bivariate linear regression (used for continuous variables) found the ICBG cohort to have an extended operative time (+36.0 min, P < 0.001) and extended LOS (+0.6 d, P < 0.001).Multivariate analyses controlling for comorbidities, demographics, and approach-determined postoperative blood transfusion (odds ratio, 1.5), extended operative time (+22.0 min, P < 0.001), and LOS (+0.2 d, P = 0.037) to be significantly associated with ICBG use.No other adverse event was significantly associated with ICBG use. Readmission rates were not significantly different.
CONCLUSION
This study used a large national database cohort and identified increased postoperative blood transfusion, extended operative time, and increased LOS as short-term outcomes associated with ICBG on multivariate analysis. Other short-term morbidities were not significantly associated with ICBG. Readmission rates were not affected.
LEVEL OF EVIDENCE
研究设计
对13927例患者进行回顾性队列研究，其中820例接受了髂嵴骨移植（ICBG）。
目的
通过多变量分析控制潜在的混杂因素，比较接受ICBG的患者与未接受ICBG的患者的不良事件、住院时间（LOS）和再入院情况。
背景数据总结
在脊柱融合手术中使用ICBG与手术时间延长、住院时间延长和供区并发症增加有关。昂贵的骨移植替代物的开发就是基于这些问题。关于骨移植采集对住院时间和再入院率影响的数据很少，且尚未使用多变量分析来控制混杂因素。
方法
回顾性分析前瞻性收集的2010 - 2012年美国外科医师学会国家外科质量改进项目数据库中的数据。这包括人口统计学、合并症、手术数据以及医院和30天随访结果数据，包括不良事件、住院时间和再入院情况。
结果
仅5.9%的脊柱融合手术使用ICBG。二元逻辑回归（用于分类变量）发现ICBG组术后输血的可能性更高（11.6%对5.5%，P < 0.001）。二元线性回归（用于连续变量）发现ICBG组手术时间延长（+36.0分钟，P < 0.001），住院时间延长（+0.6天，P < 0.001）。控制合并症、人口统计学和手术方式后进行的多变量分析确定，术后输血（比值比，1.5）、手术时间延长（+22.0分钟，P < 0.001）和住院时间延长（+0.2天，P = 0.037）与使用ICBG显著相关。没有其他不良事件与使用ICBG显著相关。再入院率没有显著差异。
结论
本研究使用了一个大型的全国数据库队列，并通过多变量分析确定，术后输血增加、手术时间延长和住院时间增加是与ICBG相关的短期结果。其他短期并发症与ICBG没有显著关联。再入院率未受影响。
证据级别
4级。
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