Kalakoti Piyush, Missios Symeon, Maiti Tanmoy, Konar Subhas, Bir Shyamal, Bollam Papireddy, Nanda Anil
Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
World Neurosurg. 2016 Jan;85:114-24. doi: 10.1016/j.wneu.2015.08.020. Epub 2015 Aug 28.
The present study investigates outcomes in patients undergoing elective primary versus revision fusion surgery for lumbar degenerative pathologies with the use of a large population based database.
A total of 126,044 patients registered in the National Inpatient Sample (NIS) database were identified to have undergone elective fusion of the lumbar spine (primary fusion: 94%; redo fusion: 6%) for degenerative pathologies, between 2002 and 2011. A multivariable logistic regression model was built that adjusted for patient demographics and clinical and hospital characteristics to explore clinical outcomes and postoperative complications.
The mean age of the cohort was 54.91 ± 13.98 years, and 58% were women. Multivariable regression analysis revealed patients undergoing redo lumbar fusion had a greater likelihood for an unfavorable discharge (odds ratio [OR] 1.17; 95% confidence interval [95% CI] 1.08-1.26; P < 0.0001), prolonged length of stay (OR: 1.80; 95% CI 1.68-1.92; P < 0.0001), greater hospital charges (OR 1.60; 95% CI 1.51-1.71; P < 0.0001), neurologic complications including dural tears and nerve root injuries (OR 2.06; 95% CI 1.80-2.37; P < 0.0001), deep venous thrombosis (OR 2.35; 95% CI 1.76-3.14; P < 0.0001), pulmonary embolism (OR 1.72; 95% CI 1.45-2.03; P < 0.0001), would infections (OR 2.40; 95% CI 1.79-3.22; P < 0.0001) and wound complications (OR 1.59; 95% CI 1.32-1.91; P < 0.0001), and gastrointestinal complications (OR 1.23; 95% CI 1.04-1.45; P = 0.016), compared with patients undergoing a primary lumbar fusion procedure.
The association of a likely postoperative complication in patients undergoing revision lumbar spine fusion compared with those undergoing primary fusion procedures at the same region of the spine is quantified. Our analysis provides baseline estimates that could aid in preoperative risk stratification and as an adjunct in patient education and counseling, and policy makers for higher reimbursements for these sicker patients.
本研究利用一个基于大量人群的数据库，调查因腰椎退行性病变接受择期初次融合手术与翻修融合手术患者的治疗结果。
在2002年至2011年期间，从国家住院样本（NIS）数据库中确定了总共126,044例因退行性病变接受腰椎择期融合手术的患者（初次融合：94%；再次融合：6%）。建立了一个多变量逻辑回归模型，对患者人口统计学以及临床和医院特征进行调整，以探讨临床结果和术后并发症。
该队列的平均年龄为54.91±13.98岁，58%为女性。多变量回归分析显示，接受腰椎再次融合手术的患者出现不良出院情况的可能性更大（优势比[OR]为1.17；95%置信区间[95%CI]为1.08 - 1.26；P<0.0001），住院时间延长（OR：1.80；95%CI为1.68 - 1.92；P<0.0001），医院费用更高（OR为1.60；95%CI为1.51 - 1.71；P<0.0001），出现包括硬脊膜撕裂和神经根损伤在内的神经并发症（OR为2.06；95%CI为1.80 - 2.37；P<0.0001），深静脉血栓形成（OR为2.35；95%CI为1.76 - 3.14；P<0.0001），肺栓塞（OR为1.72；95%CI为1.45 - 2.03；P<0.0001），伤口感染（OR为2.40；95%CI为1.79 - 3.22；P<0.0001）和伤口并发症（OR为1.59；95%CI为1.32 - 1.91；P<0.0001），以及胃肠道并发症（OR为1.23；95%CI为1.04 - 1.45；P = 0.016），与接受初次腰椎融合手术的患者相比。
对腰椎翻修融合手术患者与在脊柱同一区域接受初次融合手术患者术后可能发生并发症的关联进行了量化。我们的分析提供了基线估计值，有助于术前风险分层，并作为患者教育和咨询的辅助手段，也可为政策制定者对这些病情较重患者给予更高报销提供参考。
