量化成人脊柱畸形手术风险的新型指标：一项对来自全国住院患者样本的10912例患者的研究。

Novel Index to Quantify the Risk of Surgery in the Setting of Adult Spinal Deformity: A Study on 10,912 Patients From the Nationwide Inpatient Sample.

作者信息

Diebo Bassel G, Jalai Cyrus M, Challier Vincent, Marascalchi Bryan J, Horn Samantha R, Poorman Gregory W, Bono Olivia J, Cherkalin Denis, Worley Nancy, Oh Jason, Naziri Qais, Spitzer Allison, Radcliff Kris, Patel Ashish, Lafage Virginie, Paulino Carl B, Passias Peter G

机构信息

*Department of Orthopaedic Surgery, State University of New York, Downstate Medical Center, Brooklyn †Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY ‡Spine Unit 1, Orthopedic Surgery Department, Bordeaux University Hospital, Bordeaux, France §Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD ∥Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, Philadelphia, PA ¶Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.

出版信息

Clin Spine Surg. 2017 Aug;30(7):E993-E999. doi: 10.1097/BSD.0000000000000509.

DOI:10.1097/BSD.0000000000000509

PMID:28169941

Abstract

STUDY DESIGN

Retrospective review of the Nationwide Inpatient Sample from 2001 to 2010, a prospectively collected national database.

OBJECTIVE

Structure an index to quantify adult spinal deformity (ASD) surgical risk based on risk factors for medical complications, surgical complications, revisions (R), mortality (M) rates, and length of hospital stay.

SUMMARY OF BACKGROUND DATA

Evidence supporting ASD surgery cost-effectiveness and anticipating surgical risk is critical to evaluate the risk/benefit balance of such treatment for patients.

MATERIALS AND METHODS

Discharges ages 25+, 4+ levels fused, diagnoses specific for scoliosis, and refusions. Five multivariate models determined independent risk factors that increased the risk of ≥1 for medical complications, surgical complications, R, M, and length of hospital stay. Models controlled for age, sex, race, revision status, surgical approach, levels fused, and osteotomy utilization. Odds ratios (ORs) were weighted using Nationwide Inpatient Sample weight files and based on their predictive category: 2 times for revision predictors and 4 times for mortality predictors. Predictors with OR≥1.5 were considered clinically relevant. Fifty points were distributed among the predictors based on their accumulative OR to establish a risk index.

RESULTS

A total of 10,912 ASD discharges were identified (mean age: 62 y; 73% females; 14% revision cases). The structured risk index incorporated the following factors based on accumulative ORs: pulmonary circulation disorder (42.05), drug abuse (21.86), congestive heart failure (15.25), neurological disorder (17.31), alcohol abuse (13.24), renal failure (11.64), age>65 (12.28), coagulopathy (11.65), level +9 (6.7), revision (3.35), and osteotomy (3). These risk factors were scored: 14, 7, 5, 5, 4, 4, 4, 4, 2, 1, 1, respectively. Three risk thresholds were proposed: mild (0-10), moderate (10-20), severe >20/50 points.

CONCLUSIONS

This study proposes an index to quantify the possible risk of morbidity before ASD surgery that will help patients, health insurance companies, and socioeconomic studies in assessing surgical risk/benefits.

LEVEL OF EVIDENCE

Level III.

摘要

研究设计

对2001年至2010年全国住院患者样本进行回顾性分析，该样本为前瞻性收集的全国数据库。

目的

基于医疗并发症、手术并发症、翻修（R）、死亡率（M）以及住院时间的风险因素，构建一个量化成人脊柱畸形（ASD）手术风险的指数。

背景数据总结

支持ASD手术成本效益及预测手术风险的证据对于评估此类治疗对患者的风险/获益平衡至关重要。

材料与方法

年龄25岁及以上、融合节段4个及以上、诊断为脊柱侧弯且无拒诊的出院病例。五个多变量模型确定了增加医疗并发症、手术并发症、翻修、死亡以及住院时间中至少一项风险≥1的独立风险因素。模型对年龄、性别、种族、翻修状态、手术方式、融合节段以及截骨术的使用情况进行了控制。优势比（OR）使用全国住院患者样本权重文件进行加权，并根据其预测类别进行加权：翻修预测因子加权2倍，死亡预测因子加权4倍。OR≥1.5的预测因子被视为具有临床相关性。根据预测因子的累积OR在其中分配50分以建立风险指数。

结果

共识别出10912例ASD出院病例（平均年龄：62岁；73%为女性；14%为翻修病例）。基于累积OR构建的结构化风险指数纳入了以下因素：肺循环障碍（42.05）、药物滥用（21.86）、充血性心力衰竭（15.25）、神经疾病（17.31）、酒精滥用（13.24）、肾衰竭（11.64）、年龄>65岁（12.28）、凝血障碍（11.65）、节段数+9（6.7）、翻修（3.35）以及截骨术（3）。这些风险因素的得分分别为：14、7、5、5、4、4、4、4、2、1、1。提出了三个风险阈值：轻度（0 - 10）、中度（10 - 20）、重度>20/50分。