成人脊柱侧弯手术中外科医生经验与并发症发生率之间的关联：对脊柱侧弯研究学会数据库2004 - 2007年5117例病例的回顾
Association Between Surgeon Experience and Complication Rates in Adult Scoliosis Surgery: A Review of 5117 Cases From the Scoliosis Research Society Database 2004-2007.
作者信息
Skovrlj Branko, Cho Samuel K, Caridi John M, Bridwell Keith H, Lenke Lawrence G, Kim Yongjung J
机构信息
From the Departments of *Neurosurgery and †Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY ‡Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO; and §Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
出版信息
Spine (Phila Pa 1976). 2015 Aug 1;40(15):1200-5. doi: 10.1097/BRS.0000000000000993.
STUDY DESIGN
Retrospective review of a multicenter database.
OBJECTIVE
To evaluate whether surgeon experience is associated with complication rates in adult spinal deformity (ASD) surgery.
SUMMARY OF BACKGROUND DATA
Multiple patient- and surgery-related factors have been shown to increase the risk of complications in ASD. No study exists evaluating surgeon experience as an associated factor with complications in ASD.
METHODS
The Scoliosis Research Society Morbidity and Mortality database was queried for patients older than 18 years who underwent ASD from 2004 to 2007. Patient demographics, surgical characteristics, complications, and surgeon membership status were analyzed. Two-tailed t test and χ tests were performed, with P value of less than 0.05 considered significant.
RESULTS
A total of 5117 patients underwent ASD surgery. The average patient age was 51.8 years. Patients operated by candidate members were older than those operated by active members (53.1 vs. 51.4, P = 0.003). Active members performed 3836 (75%) cases whereas candidate members performed 1281 cases. There were 1110 (21.7%) revisions. A total of 681 (13.3%) complications were recorded, 498 (13.0%) for active and 183 (14.3%) for candidate members, respectively (P = 0.24). Mortality rate was 0.29%. Spinal cord complications accounted for 0.68% of all cases. Active members had 21 (0.55%) spinal cord complications, whereas candidates had 14 (1.1%) (P = 0.049). There were a total of 174 (3.4%) surgical site infections (SSI). Active members had 82 (2.1%) deep SSI, whereas candidate members had 36 (2.8%) deep SSI (P = 0.164). Active members had 33 (0.9%) superficial SSI whereas candidate members had 23 (1.8%) superficial SSI (P = 0.008).
CONCLUSION
There was a statistically significant, 2-fold increase in the rate of spinal cord complications and superficial SSI among candidate compared with active members. Overall complication rates were similar between candidate and active members.
LEVEL OF EVIDENCE
研究设计
对多中心数据库进行回顾性分析。
目的
评估外科医生经验与成人脊柱畸形（ASD）手术并发症发生率之间是否存在关联。
背景资料总结
多项患者及手术相关因素已被证明会增加ASD手术并发症的风险。尚无研究评估外科医生经验作为ASD手术并发症的相关因素。
方法
查询脊柱侧弯研究学会发病率与死亡率数据库，纳入2004年至2007年接受ASD手术的18岁以上患者。分析患者人口统计学资料、手术特征、并发症及外科医生会员状态。进行双侧t检验和χ检验，P值小于0.05认为具有统计学意义。
结果
共有5117例患者接受了ASD手术。患者平均年龄为51.8岁。由候选会员手术的患者比由正式会员手术的患者年龄更大（53.1岁对51.4岁，P = 0.003）。正式会员实施了3836例（75%）手术，而候选会员实施了1281例。有1110例（21.7%）翻修手术。共记录到681例（13.3%）并发症，正式会员有498例（13.0%），候选会员有183例（14.3%）（P = 0.24）。死亡率为0.29%。脊髓并发症占所有病例的0.68%。正式会员有21例（0.55%）脊髓并发症，而候选会员有14例（1.1%）（P = 0.049）。共有174例（3.4%）手术部位感染（SSI）。正式会员有82例（2.1%）深部SSI，而候选会员有36例（2.8%）深部SSI（P = 0.164）。正式会员有33例（0.9%）浅表SSI，而候选会员有23例（1.8%）浅表SSI（P = 0.008）。
结论
与正式会员相比，候选会员的脊髓并发症和浅表SSI发生率在统计学上显著增加了2倍。候选会员和正式会员的总体并发症发生率相似。
证据级别
4级。
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