肥胖与腰椎手术中硬脊膜意外切开率的增加有关。
Obesity is associated with an increased rate of incidental durotomy in lumbar spine surgery.
作者信息
Burks Christopher A, Werner Brian C, Yang Scott, Shimer Adam L
机构信息
From the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
出版信息
Spine (Phila Pa 1976). 2015 Apr 1;40(7):500-4. doi: 10.1097/BRS.0000000000000784.
STUDY DESIGN
Retrospective database analysis.
OBJECTIVE
To determine the impact of obesity on the rate of incidental durotomy in lumbar spine surgery.
SUMMARY OF BACKGROUND DATA
There is a paucity of data on the overall impact of obesity on the rate of incidental durotomy in lumbar spine surgery, specifically with regard to the type of procedure performed.
METHODS
A large administrative database was queried for all patients who underwent lumbar spine surgery for decompression and/or fusion. They were then stratified into separate cohorts on the basis of body mass index and by procedural codes. Documentation of incidental durotomy was noted. Patient demographics and associated comorbidities were assessed. Odds ratios and 95% confidence intervals were calculated and χ test was used to assess for statistical significance.
RESULTS
The incidental durotomy ranged from 0.5% to 2.6%, with the highest rates observed in multilevel laminectomies and revision decompressions in the obese and morbidly obese groups. For patients who underwent decompression only procedures, nonobese patients had a significantly lower rate of durotomy than the obese and morbidly obese cohorts. For patients who underwent fusion with or without decompression, there was a significantly increased rate of durotomy in obese patients compared with nonobese patients. The morbidly obese cohort also had significantly higher rates of incidental durotomy than the nonobese cohort in both revision decompression and revision fusion procedures.
CONCLUSION
This analysis of a large administrative database demonstrates that obesity is associated with increased rates of incidental durotomy in lumbar spine surgery. Furthermore, obesity, in association with increasing complexity of the procedure, increases the rate of incidental durotomy in lumbar spine surgery. Surgeons must be aware of these increased risks as the rate of obesity increases in the population.
LEVEL OF EVIDENCE
研究设计
回顾性数据库分析。
目的
确定肥胖对腰椎手术中硬脊膜意外切开发生率的影响。
背景数据总结
关于肥胖对腰椎手术中硬脊膜意外切开发生率的总体影响，尤其是与所施行手术类型相关的数据较少。
方法
查询一个大型管理数据库，获取所有接受腰椎减压和/或融合手术的患者。然后根据体重指数和手术编码将他们分层为不同队列。记录硬脊膜意外切开的情况。评估患者人口统计学特征和相关合并症。计算优势比和95%置信区间，并使用χ检验评估统计学显著性。
结果
硬脊膜意外切开发生率在0.5%至2.6%之间，在肥胖和病态肥胖组的多节段椎板切除术和翻修减压术中观察到最高发生率。对于仅接受减压手术的患者，非肥胖患者的硬脊膜切开发生率显著低于肥胖和病态肥胖队列。对于接受融合手术（无论是否合并减压）的患者，肥胖患者的硬脊膜切开发生率相比非肥胖患者显著增加。在翻修减压术和翻修融合手术中，病态肥胖队列的硬脊膜意外切开发生率也显著高于非肥胖队列。
结论
对一个大型管理数据库的分析表明，肥胖与腰椎手术中硬脊膜意外切开发生率增加相关。此外，肥胖与手术复杂性增加相关，会提高腰椎手术中硬脊膜意外切开的发生率。随着人群中肥胖率的增加，外科医生必须意识到这些增加的风险。
证据级别
3级。
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