颈椎手术中的骨质疏松症
Osteoporosis in Cervical Spine Surgery.
作者信息
Guzman Javier Z, Feldman Zachary M, McAnany Steven, Hecht Andrew C, Qureshi Sheeraz A, Cho Samuel K
机构信息
From the Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
出版信息
Spine (Phila Pa 1976). 2016 Apr;41(8):662-8. doi: 10.1097/BRS.0000000000001347.
STUDY DESIGN
Retrospective administrative database analysis.
OBJECTIVE
To investigate the effect of osteoporosis (OS) on complications and outcomes in patients undergoing cervical spine surgery.
SUMMARY OF BACKGROUND DATA
OS is the most prevalent degenerative human bone disease, and spine surgeons will inevitably perform procedures on patients with OS. These patients might present a difficult patient cohort because many fixation techniques depend on bone quality and adequate bone healing--both of which are compromised in OS.
METHODS
The nationwide inpatient sample was queried using the Ninth Revision, Clinical Modification procedural codes for cervical spine procedures and diagnosis codes for degenerative conditions of cervical spine from 2002 to 2011. Patients were separated into two cohorts, those patients with OS and those without OS. Demographics, hospital characteristics, and adjusted complication likelihood were analyzed. Multivariate regression analysis was performed to determine odds of revision surgery in patients with OS.
RESULTS
Of all patients undergoing degenerative cervical spine surgery, 2% were identified as having OS (32,557 of a sample of 1,602,129 patients). Osteoporotic patients were more likely to undergo posterior cervical spine fusion when compared with those patients without OS (11.3% vs. 5.4%, P < 0.0001). Moreover, circumferential fusion was performed 3 times more frequently in the osteoporotic cohort. Adjusted complications showed increased odds for postoperative hemorrhage (odds ratio = 1.70, 95% confidence interval = 1.46-1.98, P < 0.0001). Patients with OS stayed in the hospital longer (3.5 vs. 2.5 days, P < 0.0001) and had 30% costlier hospitalizations. Multivariate for revision surgery indicated that osteoporotic patients had significantly increased odds of revision surgery (odds ratio = 1.54, P ≤ 0.0001) when referenced to non-osteoporotic patients undergoing cervical spine surgery.
CONCLUSION
Osteoporotic patients were more likely to undergo revision surgery, have longer hospitalizations, and have higher hospitalization costs, than their non-osteoporotic counterparts.
LEVEL OF EVIDENCE
研究设计
回顾性管理数据库分析。
目的
探讨骨质疏松症（OS）对接受颈椎手术患者并发症及手术结果的影响。
背景资料总结
OS是最常见的人类退行性骨病，脊柱外科医生不可避免地要为患有OS的患者实施手术。这些患者可能构成一个棘手的患者群体，因为许多固定技术依赖于骨质质量和充分的骨愈合——而这两者在OS患者中均受到损害。
方法
利用第九版临床修正版程序编码查询2002年至2011年全国住院患者样本中的颈椎手术程序编码以及颈椎退行性疾病的诊断编码。患者被分为两组，即患有OS的患者和未患有OS的患者。分析人口统计学、医院特征以及调整后的并发症可能性。进行多变量回归分析以确定OS患者再次手术的几率。
结果
在所有接受颈椎退行性疾病手术的患者中，2%被确定患有OS（1,602,129例患者样本中有32,557例）。与未患OS的患者相比，骨质疏松症患者更有可能接受颈椎后路融合手术（11.3%对5.4%，P<0.0001）。此外，在骨质疏松症患者组中，环形融合手术的实施频率高出3倍。调整后的并发症显示术后出血几率增加（比值比=1.70，95%置信区间=1.46 - 1.98，P<0.0001）。患有OS的患者住院时间更长（3.5天对2.5天，P<0.0001），住院费用高出30%。再次手术的多变量分析表明，与接受颈椎手术的非骨质疏松症患者相比，骨质疏松症患者再次手术的几率显著增加（比值比=1.54，P≤0.0001）。
结论
与非骨质疏松症患者相比，骨质疏松症患者更有可能接受再次手术，住院时间更长，住院费用更高。
证据级别
3级。
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