De la Garza Ramos Rafael, Goodwin C Rory, Passias Peter G, Neuman Brian J, Kebaish Khaled M, Lafage Virginie, Schwab Frank, Sciubba Daniel M
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Ave, Bronx, NY 10467, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA.
Spine Deform. 2017 Mar;5(2):145-150. doi: 10.1016/j.jspd.2016.10.009.
Cross-sectional study of a national surgical database.
To investigate the timing of complications after adult spinal deformity (ASD) surgery.
There is limited data on the range of days when complications after ASD surgery occur.
The American College of Surgeons National Surgical Quality Improvement database was reviewed for the years 2007-2013. Inclusion criteria were adult patients (over 21 years of age) who underwent spinal fusion for ASD. Ten unique complications occurring within 30 postoperative days were examined and the median day to diagnosis was recorded.
A total of 1,250 patients met inclusion criteria with an overall complication rate of 13.5%. The median day of diagnosis (and interquartile range) for each complication was as follows: myocardial infarction (3.5, 1-5), pulmonary embolism (4, 2-16), reintubation (4.5, 1-11), pneumonia (6, 3-9), urinary tract infection (11, 5-15), sepsis (12, 6-18.5), deep vein thrombosis (12, 6-19), deep surgical site infection (SSI; 18.5, 13-23), superficial SSI (19, 13-24), and organ space SSI (21, 17-25). The three complications that were most commonly diagnosed before hospital discharge included pneumonia, reintubation, and myocardial infarction (diagnosed before discharge on more than 70% of cases). On the other hand, superficial, deep, and organ space infection were diagnosed in less than 40% of cases before patients left the hospital. On univariate analysis, predictors of complication occurrence included older age (p = .014), instrumentation of 7-12 levels (p = .034), and instrumentation of 13 or more levels (p = .035).
Understanding the timing of specific complications after adult spinal deformity surgery is important for both patients and clinicians. Efforts in prevention of such conditions should continue, as well as heightened awareness during the periods of highest risk.
对一个全国性手术数据库进行横断面研究。
调查成人脊柱畸形（ASD）手术后并发症的发生时间。
关于ASD手术后并发症发生天数范围的数据有限。
回顾了美国外科医师学会国家外科质量改进数据库2007 - 2013年的数据。纳入标准为接受ASD脊柱融合手术的成年患者（年龄超过21岁）。检查术后30天内发生的10种独特并发症，并记录诊断的中位天数。
共有1250例患者符合纳入标准，总体并发症发生率为13.5%。每种并发症的诊断中位天数（及四分位间距）如下：心肌梗死（3.5，1 - 5）、肺栓塞（4，2 - 16）、再次插管（4.5，1 - 11）、肺炎（6，3 - 9）、尿路感染（11，5 - 15）、脓毒症（12，6 - 18.5）、深静脉血栓形成（12，6 - 19）、深部手术部位感染（SSI；18.5，13 - 23）、浅表SSI（19，13 - 24）和器官腔隙SSI（21，17 - 25）。在出院前最常被诊断出的三种并发症包括肺炎、再次插管和心肌梗死（超过70%的病例在出院前被诊断）。另一方面，在患者出院前，浅表、深部和器官腔隙感染在不到40%的病例中被诊断出。单因素分析显示，并发症发生的预测因素包括年龄较大（p = .014）、7 - 12节段的内固定（p = .034）以及13节段或更多节段的内固定（p = .035）。
了解成人脊柱畸形手术后特定并发症的发生时间对患者和临床医生都很重要。应继续努力预防此类情况，并在风险最高的时期提高警惕。
