Kothari Parth, Lee Nathan J, Leven Dante M, Lakomkin Nikita, Shin John I, Skovrlj Branko, Steinberger Jeremy, Guzman Javier Z, Cho Samuel K
Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Orthopedic Surgery, SUNY Health Science Center at Brooklyn, Brooklyn, NY.
Spine (Phila Pa 1976). 2016 Jul 15;41(14):1133-1138. doi: 10.1097/BRS.0000000000001499.
Retrospective study of prospectively collected data.
To determine if postoperative morbidity for patients undergoing spinal deformity surgery varies by sex.
Influence of sex has been investigated in other surgical procedures but has not yet been studied in adult spinal deformity surgery.
The American College of Surgeons National Surgical Quality Improvement Program is a large multicenter clinical registry that prospectively collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from about 400 hospitals nationwide. Current Procedural Terminology codes were used to query the database for adults who underwent fusion for spinal deformity. Patients were separated into groups of male and female sex. Univariate analysis and multivariate logistic regression were used to analyze the effect of sex on the incidence of postoperative morbidity and mortality.
Female sex was found to be a predictor of any complication[odds ratio (OR): 1.4, 95% confidence interval (CI) 1.2-1.7, P < 0.0001], intra- or postoperative RBC transfusion (OR: 1.6, 95% CI 1.4-1.9, P < .0001), urinary tract infection (OR: 2.0, 95% CI 1.2-3.3, P = 0.0046), and length of stay >5 days (OR: 1.3, 95% CI 1.1-1.5, P = 0.0015). Male sex was associated with higher rate of pulmonary (2.9% vs. 2.0%, P = 0.0344) and cardiac complications (0.9% vs. 0.5%, P = 0.0497). However, male sex as an independent risk factor for pulmonary (OR: 1.4, 95% CI 1.0-2.1, P = 0.0715) and cardiac complications (OR: 1.9, 95% CI 0.9-4.0, P = 0.1076) did not reach significance.
Female sex was found to increase overall morbidity, particularly for urinary tract infection, transfusion, and length of stay >5 days. Male sex was associated with greater incidence of pulmonary and cardiac complications. Thus, sex and other patient characteristics highlighted must be considered as part of surgical risk planning and patient counseling.
对前瞻性收集的数据进行回顾性研究。
确定接受脊柱畸形手术患者的术后发病率是否因性别而异。
性别对其他外科手术的影响已得到研究，但在成人脊柱畸形手术中尚未进行研究。
美国外科医师学会国家外科质量改进计划是一个大型多中心临床注册机构，前瞻性收集全国约400家医院的术前危险因素、术中变量以及术后30天的发病率和死亡率结果。使用当前手术操作术语编码在数据库中查询接受脊柱畸形融合手术的成年人。患者被分为男性组和女性组。采用单因素分析和多因素逻辑回归分析性别对术后发病率和死亡率的影响。
发现女性是任何并发症的预测因素[比值比（OR）：1.4，95%置信区间（CI）1.2 - 1.7，P<0.0001]、术中或术后红细胞输血（OR：1.6，95%CI 1.4 - 1.9，P<0.0001）、尿路感染（OR：2.0，95%CI 1.2 - 3.3，P = 0.0046）以及住院时间>5天（OR：1.3，95%CI 1.1 - 1.5，P = 0.0015）的预测因素。男性肺部并发症（2.9%对2.0%，P = 0.0344）和心脏并发症（0.9%对0.5%，P = 0.0497）的发生率较高。然而，男性作为肺部（OR：1.4，95%CI 1.0 - 2.1，P = 0.0715）和心脏并发症（OR：1.9，95%CI 0.9 - 4.0，P = 0.1076）的独立危险因素未达到显著水平。
发现女性会增加总体发病率，尤其是尿路感染、输血以及住院时间>5天的情况。男性与肺部和心脏并发症的发生率较高相关。因此，性别以及所强调的其他患者特征必须作为手术风险规划和患者咨询的一部分加以考虑。
3级。
