择期后路腰椎融合术后主要并发症的危险因素分析。
Analysis of Risk Factors for Major Complications Following Elective Posterior Lumbar Fusion.
机构信息
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.
出版信息
Spine (Phila Pa 1976). 2017 Sep 1;42(17):1347-1354. doi: 10.1097/BRS.0000000000002090.
STUDY DESIGN
Retrospective study of prospectively collected data.
OBJECTIVE
To identify risk factors for the development of any major complication after elective posterior lumbar fusion (PLF).
SUMMARY OF BACKGROUND DATA
PLF is one of the most performed fusion techniques with utilization rates increasing by 356% between 1993 and 2001. Surgical and anesthetic advances have made the option of surgery more accessible for elderly patients with a larger comorbidity burden. Identifying risk factors for the development of major complications after elective PLF is important for patient risk stratification and patient safety efforts.
METHODS
The 2011 to 2014 American College of Surgeon's National Surgical Quality Improvement Program database was queried using Current Procedural Terminology codes 22612, 22630, and 22633. Patients were divided into two cohorts based on the development of any major complication. Bivariate and multivariate logistic regression analyses were employed to identify predictors for the development of ≥ 1, ≥ 2, and ≥ 3 major complications.
RESULTS
A total of 7761 patients met the inclusion criteria for the study of which, 2055 (26.5%) patients developed one major complication, 249 (3.2%) patients developed two major complications, and 151 (1.9%) patients developed three major complications. The most common complication was intra/postoperative red blood cell transfusion (23.2%). Three multivariate logistic regression models were employed to identify factors associated with ≥ 1, ≥ 2, and ≥ 3 major complications. Patient variables present across all three models were osteotomy, pelvic fixation, operation time ≥4 hours, bleeding disorder, and American Society of Anesthesiology Class ≥ 3.
CONCLUSION
Several risk factors were identified for the development of major complications after elective PLF. Identification of these factors can improve the selection of appropriate surgical candidates, patient risk stratification, and patient postoperative safety.
LEVEL OF EVIDENCE
研究设计
前瞻性收集数据的回顾性研究。
目的
确定择期后路腰椎融合术（PLF）后发生任何主要并发症的危险因素。
背景数据概要
PLF 是最常进行的融合技术之一，1993 年至 2001 年间使用率增长了 356%。手术和麻醉技术的进步使患有更大合并症负担的老年患者更容易选择手术。确定择期 PLF 后发生主要并发症的危险因素对于患者风险分层和患者安全工作非常重要。
方法
使用当前手术程序分类代码 22612、22630 和 22633 查询 2011 年至 2014 年美国外科医师学会国家手术质量改进计划数据库。根据是否发生任何主要并发症将患者分为两组。使用双变量和多变量逻辑回归分析确定发生≥1、≥2 和≥3 种主要并发症的预测因素。
结果
共有 7761 名患者符合本研究的纳入标准，其中 2055 名（26.5%）患者发生 1 种主要并发症，249 名（3.2%）患者发生 2 种主要并发症，151 名（1.9%）患者发生 3 种主要并发症。最常见的并发症是围手术期内/后红细胞输血（23.2%）。使用三个多变量逻辑回归模型来确定与≥1、≥2 和≥3 种主要并发症相关的因素。所有三个模型中都存在的患者变量是截骨术、骨盆固定、手术时间≥4 小时、出血性疾病和美国麻醉医师协会分类≥3。
结论
确定了择期 PLF 后发生主要并发症的几个危险因素。识别这些因素可以提高选择合适手术候选者的能力、患者风险分层和患者术后安全性。
证据水平
3 级。
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