儿童初次与翻修脊柱融合术：来自全国住院患者样本的74525例病例分析。
Primary Versus Revision Spinal Fusion in Children: An Analysis of 74,525 Cases From the Nationwide Inpatient Sample.
作者信息
De la Garza Ramos Rafael, Goodwin C Rory, Purvis Taylor, Karikari Isaac O, Samdani Amer F, Sciubba Daniel M
机构信息
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
出版信息
Spine (Phila Pa 1976). 2017 Jun 1;42(11):E660-E665. doi: 10.1097/BRS.0000000000001924.
STUDY DESIGN
Retrospective cohort study of a nationwide database.
OBJECTIVE
To compare in-hospital outcomes for pediatric patients who underwent primary versus revision spinal fusion.
SUMMARY OF BACKGROUND DATA
There is limited data on outcomes after primary versus revision spinal fusion in children.
METHODS
Data from the Nationwide Inpatient Sample from 2002 to 2011 were analyzed. Pediatric patients (age <18 yr) who underwent ≥3 level spinal fusion were identified. Demographics, in-hospital complications, length of stay, and hospital charges were compared between primary and revision (refusion) procedures. All analyses were performed after application of discharge weights.
RESULTS
Data from 72,483 primary fusion and 2042 revision fusion procedures (2.7%) were analyzed. Average length of stay was 7.9 days for the revision group and 6.6 for the primary group (P = 0.022). Average total charges were $135,644 and $142,029 for the revision and primary fusion groups, respectively (P = 0.252). The percentage of patients who developed at least one in-hospital complication was 16.7% in the revision group and 8.6% in the primary fusion group (P < 0.001). Specific complications that were more common in the revision group were reintubation (4.3% vs. 2.3%, P = 0.008), hemorrhage/hematoma (5.0% vs. 2.5%, P = 0.001), wound complications (4.0% vs. 1.1%, P < 0.001), accidental vessel/nerve puncture (2.6% vs. 0.8%, P < 0.001), implant-related complications (5.3% vs. 0.4%, P < 0.001), and incidental durotomy (2.1% vs. 0.3%, P < 0.001). On multivariate analysis, revision procedures (odds ratio [OR] 2.64; 95% confidence interval [CI] 1.93-3.59; P < 0.001), male sex (OR 1.73; 95% CI 1.52-1.98; P < 0.001), and fusion of eight or more spinal levels (OR 1.27; 95% CI 1.09-1.47; P = 0.001) were risk factors for complication development.
CONCLUSION
In the present study, pediatric patients who underwent spinal refusion had significantly higher complication rates compared to patients who underwent primary fusion, consistent with previous investigations. Male patients and patients who underwent fusion of eight or more spinal levels also had higher complication rates.
LEVEL OF EVIDENCE
研究设计
对全国性数据库进行回顾性队列研究。
目的
比较接受初次与翻修脊柱融合术的儿科患者的住院结局。
背景数据总结
关于儿童初次与翻修脊柱融合术后结局的数据有限。
方法
分析2002年至2011年全国住院患者样本的数据。确定接受≥3节段脊柱融合术的儿科患者（年龄<18岁）。比较初次手术与翻修（再次融合）手术之间的人口统计学、住院并发症、住院时间和住院费用。所有分析均在应用出院权重后进行。
结果
分析了72483例初次融合手术和2042例翻修融合手术（2.7%）的数据。翻修组的平均住院时间为7.9天，初次组为6.6天（P = 0.022）。翻修融合组和初次融合组的平均总费用分别为135644美元和142029美元（P = 0.252）。发生至少一种住院并发症的患者百分比在翻修组为16.7%，在初次融合组为8.6%（P < 0.001）。翻修组中更常见的特定并发症有再次插管（4.3%对2.3%，P = 0.008）、出血/血肿（5.0%对2.5%，P = 0.001）、伤口并发症（4.0%对1.1%，P < 0.001）、意外血管/神经穿刺（2.6%对0.8%，P < 0.001）、植入物相关并发症（5.3%对0.4%，P < 0.001）和意外硬脊膜切开（2.1%对0.3%，P < 0.001）。多因素分析显示，翻修手术（比值比[OR] 2.64；95%置信区间[CI] 1.93 - 3.59；P < 0.001）、男性（OR 1.73；95% CI 1.52 - 1.98；P < 0.001）以及融合8个或更多脊柱节段（OR 1.27；95% CI 1.09 - 1.47；P = 0.001）是并发症发生的危险因素。
结论
在本研究中，与接受初次融合的患者相比，接受脊柱翻修的儿科患者并发症发生率显著更高，这与先前的研究一致。男性患者以及接受8个或更多脊柱节段融合的患者并发症发生率也更高。
证据级别
3级。
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