Desai Rupen, Nayar Gautam, Suresh Visakha, Wang Timothy Y, Loriaux Daniel, Martin Joel R, Gottfried Oren N
Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
J Clin Neurosci. 2016 Jul;29:100-5. doi: 10.1016/j.jocn.2015.12.012. Epub 2016 Feb 28.
We investigated the effect of preoperative patient demographics and operative factors on mortality in the 30day postoperative period after spine surgery. Postoperative mortality from surgical interventions has significantly decreased with progressive improvement in surgical techniques and patient selection. Well-studied preoperative risk factors include age, obesity, emphysema, clotting disorders, renal failure, and cardiovascular disease. However, the prognostic implications of such risk factors after spine surgery specifically remain unknown. The medical records of all consecutive patients undergoing spine surgery from 2008-2010 at our institution were reviewed. Patient demographics, comorbidities, indication for operation, surgical details, postoperative complications, and mortalities were collected. The association between preoperative demographics or surgical details and postoperative mortality was assessed via logistic regression analysis. All 1344 consecutive patients (1153 elective, 191 emergency) met inclusion criteria for the study; 19 (1.4%) patients died in the 30days following surgery. Multivariable logistic regression found several predictive factors of mortality for all spine surgery patients: operation in the cervical area (odds ratio [OR]: 7.279, 95% confidence interval [CI]: 1.37-42.83, p=0.02), postoperative sepsis (OR: 5.75, 95% CI: 1.16-26.38, p=0.03), operation for neoplastic (OR: 7.68, 95% CI: 1.53-42.71, p=0.01) or traumatic (OR: 13.76, 95% CI: 2.40-88.68, p=0.03) etiology, and age as defined as a continuous variable (OR: 1.05, 95% CI: 1.01-1.10, p=0.03). This study demonstrates predictive factors to help identify and evaluate patients who are at higher risk for mortality from spinal surgery, and potentially devise methods to reduce this risk.
我们研究了脊柱手术患者术前人口统计学特征和手术因素对术后30天内死亡率的影响。随着手术技术和患者选择的逐步改善，手术干预导致的术后死亡率已显著下降。经过充分研究的术前风险因素包括年龄、肥胖、肺气肿、凝血障碍、肾衰竭和心血管疾病。然而，这些风险因素在脊柱手术后的具体预后影响仍不清楚。我们回顾了2008年至2010年在本机构接受脊柱手术的所有连续患者的病历。收集了患者的人口统计学特征、合并症、手术指征、手术细节、术后并发症和死亡率。通过逻辑回归分析评估术前人口统计学特征或手术细节与术后死亡率之间的关联。所有1344例连续患者（1153例择期手术，191例急诊手术）均符合该研究的纳入标准；19例（1.4%）患者在术后30天内死亡。多变量逻辑回归发现了所有脊柱手术患者死亡率的几个预测因素：颈椎手术（比值比[OR]：7.279，95%置信区间[CI]：1.37 - 42.83，p = 0.02）、术后脓毒症（OR：5.75，95% CI：1.16 - 26.38，p = 0.03）、肿瘤性（OR：7.68，95% CI：1.53 - 42.71，p = 0.01）或创伤性（OR：13.76，95% CI：2.40 - 88.68，p = 0.03）病因的手术，以及定义为连续变量的年龄（OR：1.05，95% CI：1.01 - 1.10，p = 0.03）。本研究证明了预测因素有助于识别和评估脊柱手术死亡风险较高的患者，并可能设计方法降低这种风险。
