De la Garza Ramos Rafael, Goodwin C Rory, Abu-Bonsrah Nancy, Jain Amit, Miller Emily K, Huang Nicole, Kebaish Khaled M, Sponseller Paul D, Sciubba Daniel M
Departments of 1 Neurosurgery and.
Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Neurosurg Pediatr. 2016 Dec;25(6):730-736. doi: 10.3171/2016.6.PEDS16200. Epub 2016 Aug 26.
OBJECTIVE The aim of this study was to investigate the incidence of and factors associated with complications following idiopathic scoliosis surgery in adolescents. METHODS The Nationwide Inpatient Sample database was used to identify patients 10-18 years of age who had undergone spinal fusion for adolescent idiopathic scoliosis (AIS) from 2002 to 2011. Twenty-three unique in-hospital postoperative complications, including death, were examined. A series of logistic regressions was used to determine if any demographic, comorbid, or surgical parameter was associated with complication development. Results of multiple logistic regression analyses were reported as odds ratios with 95% confidence intervals. All analyses were performed after the application of discharge weights to produce national estimates. RESULTS A total of 36,335 patients met the study inclusion criteria, 7.6% of whom (95% CI 6.3%-8.9%) developed at least one in-hospital complication. The 3 most common complications were respiratory failure (3.47%), reintubation (1.27%), and implant related (1.14%). Major complications such as death, pancreatitis, disseminated intravascular coagulation, visual loss, spinal cord injury, cardiac arrest, sepsis, nerve root injury, deep vein thrombosis, pulmonary embolism, shock, malignant hyperthermia, myocardial infarction, and iatrogenic stroke each had an incidence ≤ 0.2%. On multiple logistic regression analysis, an increasing age (OR 0.80) was associated with significantly lower odds of complication development; patients who were male (OR 1.80) or who had anemia (OR 2.10), hypertension (OR 2.51), or hypothyroidism (OR 2.27) or underwent revision procedures (OR 5.55) were at a significantly increased risk for complication development. The rates of postoperative complications for posterior, anterior, and combined approaches were 6.7%, 10.0%, and 19.8%, respectively (p < 0.001). Length of fusion (< 8 vs ≥ 8 levels) was not associated with complication development (p = 0.311). CONCLUSIONS Analysis of 36,335 patients who had undergone surgery for AIS revealed that younger patients, male patients, patients with a history of anemia, hypertension, or hypothyroidism, as well as those undergoing revision or anterior or combined approaches may have higher rates of postoperative complications. However, the overall complication rate was low (7.6%), and major complications had a rate ≤ 0.2% for each event. These findings suggest that surgery for AIS remains relatively safe, and future prospective investigations may further help to decrease the postoperative morbidity rate.
本研究旨在调查青少年特发性脊柱侧弯手术后并发症的发生率及相关因素。方法：使用全国住院患者样本数据库，识别2002年至2011年期间接受青少年特发性脊柱侧弯（AIS）脊柱融合手术的10至18岁患者。检查了包括死亡在内的23种独特的术后院内并发症。采用一系列逻辑回归分析来确定是否有任何人口统计学、合并症或手术参数与并发症的发生有关。多重逻辑回归分析的结果以比值比及95%置信区间的形式报告。所有分析均在应用出院权重以得出全国估计值后进行。结果：共有36335名患者符合研究纳入标准，其中7.6%（95%CI 6.3%-8.9%）发生了至少一种院内并发症。最常见的3种并发症为呼吸衰竭（3.47%）、再次插管（1.27%）和植入物相关并发症（1.14%）。死亡、胰腺炎、弥散性血管内凝血、视力丧失、脊髓损伤、心脏骤停、败血症、神经根损伤、深静脉血栓形成、肺栓塞、休克、恶性高热、心肌梗死和医源性中风等主要并发症的发生率均≤0.2%。在多重逻辑回归分析中，年龄增加（OR 0.80）与并发症发生几率显著降低相关；男性患者（OR 1.80）、患有贫血（OR 2.10）、高血压（OR 2.51）或甲状腺功能减退（OR 2.27）的患者或接受翻修手术的患者（OR 5.55）发生并发症的风险显著增加。后路、前路和联合手术方式的术后并发症发生率分别为6.7%、10.0%和19.8%（p<0.001）。融合节段长度（<8节段与≥8节段）与并发症发生无关（p=0.311）。结论：对36335例接受AIS手术的患者进行分析发现，年轻患者、男性患者、有贫血、高血压或甲状腺功能减退病史的患者，以及接受翻修手术或前路或联合手术方式的患者术后并发症发生率可能更高。然而，总体并发症发生率较低（7.6%），每种主要并发症的发生率均≤0.2%。这些发现表明，AIS手术仍然相对安全，并有望通过未来的前瞻性研究进一步降低术后发病率。
