老年人营养不良状况与腰椎融合手术：再入院、并发症及死亡率

Poor Nutrition Status and Lumbar Spine Fusion Surgery in the Elderly: Readmissions, Complications, and Mortality.

作者信息

Puvanesarajah Varun, Jain Amit, Kebaish Khaled, Shaffrey Christopher I, Sciubba Daniel M, De la Garza-Ramos Rafael, Khanna Akhil Jay, Hassanzadeh Hamid

机构信息

Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD.

Department of Neurosurgery, University of Virginia, Charlottesville, VA.

出版信息

Spine (Phila Pa 1976). 2017 Jul 1;42(13):979-983. doi: 10.1097/BRS.0000000000001969.

DOI:10.1097/BRS.0000000000001969

PMID:27831968

Abstract

STUDY DESIGN

Retrospective database review.

OBJECTIVE

To quantify the medical and surgical risks associated with elective lumbar spine fusion surgery in patients with poor preoperative nutritional status and to assess how nutritional status alters length of stay and readmission rates.

SUMMARY OF BACKGROUND DATA

There has been recent interest in quantifying the increased risk of complications caused by frailty, an important consideration in elderly patients that is directly related to comorbidity burden. Preoperative nutritional status is an important contributor to both sarcopenia and frailty and is poorly studied in the elderly spine surgery population.

METHODS

The full 100% sample of Medicare data from 2005 to 2012 were utilized to select all patients 65 to 84 years old who underwent elective 1 to 2 level posterior lumbar fusion for degenerative pathology. Patients with diagnoses of poor nutritional status within the 3 months preceding surgery were selected and compared with a control cohort. Outcomes that were assessed included major medical complications, infection, wound dehiscence, and mortality. In addition, readmission rates and length of stay were evaluated.

RESULTS

When adjusting for demographics and comorbidities, malnutrition was determined to result in significantly increased odds of both 90-day major medical complications (adjusted odds ratio, OR: 4.24) and 1-year mortality (adjusted OR: 6.16). Multivariate analysis also demonstrated that malnutrition was a significant predictor of increased infection (adjusted OR: 2.27) and wound dehiscence (adjusted OR: 2.52) risk. Length of stay was higher in malnourished patients, though 30-day readmission rates were similar to controls.

CONCLUSION

Malnutrition significantly increases complication and mortality rates, whereas also significantly increasing length of stay. Nutritional supplementation before surgery should be considered to optimize postoperative outcomes in malnourished individuals.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性数据库分析。

目的

量化术前营养状况较差的患者接受择期腰椎融合手术的内科及外科风险，并评估营养状况如何改变住院时间和再入院率。

背景资料总结

近期，人们关注量化由身体虚弱导致的并发症风险增加情况，身体虚弱是老年患者的一个重要考量因素，与共病负担直接相关。术前营养状况是肌肉减少症和身体虚弱的一个重要因素，而在老年脊柱手术人群中对其研究较少。

方法

利用2005年至2012年医疗保险数据的100%完整样本，选取所有65至84岁因退行性病变接受择期1至2节段后路腰椎融合术的患者。选取术前3个月内诊断为营养状况较差的患者，并与对照组进行比较。评估的结果包括主要内科并发症、感染、伤口裂开和死亡率。此外，还评估了再入院率和住院时间。

结果

在对人口统计学和共病情况进行调整后，确定营养不良会导致90天主要内科并发症（调整后的优势比，OR：4.24）和1年死亡率（调整后的OR：6.16）的几率显著增加。多因素分析还表明，营养不良是感染风险增加（调整后的OR：2.27）和伤口裂开风险增加（调整后的OR：2.52）的显著预测因素。营养不良患者的住院时间更长，尽管30天再入院率与对照组相似。