脑瘫患者脊柱手术后的主要围手术期并发症：危险因素评估
Major perioperative complications after spine surgery in patients with cerebral palsy: assessment of risk factors.
作者信息
Samdani Amer F, Belin Eric J, Bennett James T, Miyanji Firoz, Pahys Joshua M, Shah Suken A, Newton Peter O, Betz Randal R, Cahill Patrick J, Sponseller Paul D
机构信息
Shriners Hospitals for Children, Philadelphia, 3551 North Broad Street, Philadelphia, PA, 19140, USA.
Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA.
出版信息
Eur Spine J. 2016 Mar;25(3):795-800. doi: 10.1007/s00586-015-4054-3. Epub 2015 Jul 7.
PURPOSE
A prospective, longitudinal cohort was studied to determine the incidence, consequences, and risk factors of major perioperative complications in patients with cerebral palsy (CP) treated with spinal fusion. There is a wide variety of data available on the complications of spine surgery; however, little exists on the perioperative complications in patients with CP.
METHODS
A prospective multicenter dataset of consecutive patients with CP treated with spinal fusion was evaluated. All major perioperative complications were identified and stratified into categories: pulmonary, gastrointestinal, other medical, wound infection, neurological, instrumentation related, and unplanned staged surgery. Univariate and multivariate analyses were performed to identify various risk factors for major perioperative complications.
RESULTS
127 patients were identified with a mean age of 14.3 ± 2.6 years. Overall, 39.4% of the patients had a major perioperative complication. Occurrence of a complication [no complication (NC), yes complication (YC)] resulted in significantly increased intensive care unit (ICU) (NC = 3.2 days, YC = 7.8 days, p < 0.05) and hospital stays (NC = 7.7 days, YC = 15.6 days, p < 0.05). Variables associated with greater risk of a complication included: increased estimated blood loss (EBL) (p < 0.001), larger preoperative kyphosis (p = 0.05), staged procedures (p < 0.05), a lack of antifibrinolytic use (p < 0.05), and a trend toward lower body mass index (BMI) (p = 0.08). Multivariate regression analysis revealed an increased EBL as independently associated with a major perioperative complication (p < 0.05).
CONCLUSIONS
In this cohort of patients with CP who underwent spinal fusion, 39.4% experienced a major perioperative complication, with pulmonary being the most common. The occurrence of a major perioperative complication lengthened both ICU and hospital stay. Risk factors for major perioperative complications included greater preoperative kyphosis, staged procedures, a lack of antifibrinolytic use, and increased EBL, with the latter being an independent predictor of a major perioperative complication.
LEVEL OF EVIDENCE
目的
对一个前瞻性纵向队列进行研究，以确定接受脊柱融合术治疗的脑瘫（CP）患者围手术期主要并发症的发生率、后果及危险因素。关于脊柱手术并发症有大量数据；然而，关于CP患者围手术期并发症的数据却很少。
方法
对一个前瞻性多中心连续接受脊柱融合术治疗的CP患者数据集进行评估。识别所有围手术期主要并发症并分为以下类别：肺部、胃肠道、其他内科、伤口感染、神经、器械相关及计划外分期手术。进行单因素和多因素分析以识别围手术期主要并发症的各种危险因素。
结果
确定了127例患者，平均年龄为14.3±2.6岁。总体而言，39.4%的患者发生了围手术期主要并发症。发生并发症[无并发症（NC），有并发症（YC）]导致重症监护病房（ICU）住院时间显著延长（NC = 3.2天，YC = 7.8天，p < 0.05）以及住院时间延长（NC = 7.7天，YC = 15.6天，p < 0.05）。与并发症风险增加相关的变量包括：估计失血量（EBL）增加（p < 0.001）、术前脊柱后凸增大（p = 0.05）、分期手术（p < 0.05）、未使用抗纤溶药物（p < 0.05）以及体重指数（BMI）有降低趋势（p = 0.08）。多因素回归分析显示EBL增加与围手术期主要并发症独立相关（p < 0.05）。
结论
在这个接受脊柱融合术的CP患者队列中，39.4%发生了围手术期主要并发症，其中肺部并发症最为常见。围手术期主要并发症的发生延长了ICU和住院时间。围手术期主要并发症的危险因素包括术前脊柱后凸增大、分期手术、未使用抗纤溶药物以及EBL增加，其中后者是围手术期主要并发症的独立预测因素。
证据级别
2级。
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