Bohl Daniel D, Mayo Benjamin C, Massel Dustin H, Iantorno Stephanie E, Ahn Junyoung, Basques Bryce A, Grauer Jonathan N, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Spine (Phila Pa 1976). 2016 Jun;41(12):1058-1063. doi: 10.1097/BRS.0000000000001389.
Retrospective study of data collected prospectively by the American College of Surgeons National Surgical Quality Improvement Program.
To determine the incidence and risk factors for development of pneumonia after posterior lumbar fusion (PLF).
Postoperative pneumonia has important clinical consequences for patients and the health care system. Few studies have examined pneumonia after spinal fusion procedures.
Patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent PLF during 2005 to 2013 were included. The primary outcome was a diagnosis of pneumonia within the first 30 postoperative days. Independent risk factors for the development of postoperative pneumonia were identified using multivariate regression. Rates of sepsis and mortality were compared between patients who did and did not develop pneumonia using multivariate regression that adjusted for all demographic, comorbidity, and procedural characteristics.
A total of 12,428 patients undergoing PLF were identified. The incidence of pneumonia was 0.59%. Independent risk factors for the development of pneumonia were chronic obstructive pulmonary disease (relative risk [RR] = 2.7, P = 0.006), steroid use (RR = 2.6, P = 0.017), non-insulin-dependent diabetes mellitus (DM) (RR = 2.4, P = 0.003), insulin-dependent DM (RR = 2.9, P = 0.005), and greater number of operative levels (two level: RR = 1.7, P = 0.033; three level: RR = 2.7, P = 0.007). Patients who developed pneumonia had a higher rate of sepsis (15.1% vs. 0.8%, adjusted RR = 14.5, P < 0.001) and mortality (2.7% versus 0.1%, adjusted RR = 27.0, P < 0.001) than other patients. Of all sepsis cases and postoperative mortalities, 10.5% and 18.2% occurred in patients who had developed pneumonia, respectively.
Pneumonia occurs in approximately 1 in 200 patients after PLF. Pneumonia plays a significant role in the development of sepsis and mortality, with 10% of sepsis and 20% of mortality cases occurring in patients who had developed pneumonia. Patients with chronic obstructive pulmonary disease, steroid use, DM, and a greater number of operative levels are at greater risk. These patients should be counseled, monitored, and targeted with preventative interventions accordingly.
对美国外科医师学会国家外科质量改进计划前瞻性收集的数据进行回顾性研究。
确定后路腰椎融合术（PLF）后肺炎的发生率及危险因素。
术后肺炎对患者及医疗保健系统具有重要的临床影响。很少有研究探讨脊柱融合手术后的肺炎情况。
纳入美国外科医师学会国家外科质量改进计划数据库中2005年至2013年接受PLF手术的患者。主要结局为术后30天内肺炎的诊断。采用多因素回归分析确定术后肺炎发生的独立危险因素。使用对所有人口统计学、合并症和手术特征进行校正的多因素回归分析，比较发生肺炎和未发生肺炎患者的败血症发生率及死亡率。
共识别出12428例行PLF手术的患者。肺炎发生率为0.59%。肺炎发生的独立危险因素包括慢性阻塞性肺疾病（相对危险度[RR]=2.7，P=0.006）、使用类固醇（RR=2.6，P=0.017）、非胰岛素依赖型糖尿病（DM）（RR=2.4，P=0.003）、胰岛素依赖型DM（RR=2.9，P=0.005）以及手术节段数增加（两个节段：RR=1.7，P=0.033；三个节段：RR=2.7，P=0.007）。发生肺炎的患者败血症发生率（15.1%对0.8%，校正RR=14.5，P<0.001）和死亡率（2.7%对0.1%，校正RR=27.0，P<0.001）高于其他患者。在所有败血症病例和术后死亡病例中，分别有10.5%和18.2%发生在已发生肺炎的患者中。
PLF术后约每200例患者中有1例发生肺炎。肺炎在败血症和死亡率的发生中起重要作用，10%的败血症病例和20%的死亡病例发生在已发生肺炎的患者中。患有慢性阻塞性肺疾病、使用类固醇、DM以及手术节段数增加的患者风险更高。应对这些患者进行相应的咨询、监测并采取预防性干预措施。
3级。
