实体器官移植患者接受脊柱融合术的全国趋势和院内转归。
National Trends and In-Hospital Outcomes of Patients With Solid Organ Transplant Undergoing Spinal Fusion.
机构信息
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
University of Tokyo Graduate School of Medicine, Tokyo, Japan.
出版信息
Spine (Phila Pa 1976). 2017 Nov 1;42(21):E1231-E1237. doi: 10.1097/BRS.0000000000002226.
STUDY DESIGN
A retrospective analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample.
OBJECTIVE
To examine the demographics and in-hospital outcomes of patients with solid organ transplant (SOT) undergoing spinal fusion on a national level.
SUMMARY OF BACKGROUND DATA
Solid organ transplantation has become more common in recent years and some of these patients undergo spinal fusion surgery. There is, however, little information regarding the trends and outcomes in such patients.
METHODS
Clinical data were derived from the US Nationwide Inpatient Sample between 2000 and 2009. Patients with or without SOT who underwent spinal fusion were identified. Data regarding, patient- and healthcare system-related characteristics, comorbidities, in-hospital complications, and mortality were retrieved and analyzed. In-hospital outcomes were compared between patients with or without SOT and analyzed with the use of multivariate logistic regression.
RESULTS
A total of 5984 patients with SOT underwent spinal fusion in the United States during the last decade. From 2000 to 2009, population growth-adjusted incidence of patients with SOT who underwent spinal fusion has increased more than two fold (0.102 in 2000 to 0.236 in 2009, per 100,000, P < 0.001). Comparison between patients with or without SOT showed that patients with SOT had significantly higher overall in-hospital complication rate (22.4% vs. 9.5%) and in-hospital mortality rate (1.3% vs. 0.3%). Graft versus host disease occurred in 0.7% of patients with SOT undergoing spinal fusion. Patients with SOT had a significant higher risk of urinary and renal complications and overall in-hospital complications.
CONCLUSION
During the last decade, the incidence of patients with SOT undergoing spinal fusion has increased in the United States. In-hospital outcomes of patients with SOT undergoing spinal fusion were inferior to those of patients without SOT.
LEVEL OF EVIDENCE
研究设计
基于人群的全国住院患者数据的回顾性分析，这些数据是为全国住院患者样本收集的。
目的
在全国范围内检查接受脊柱融合术的实体器官移植（SOT）患者的人口统计学和住院结果。
背景数据概要
近年来，实体器官移植变得更加普遍，其中一些患者接受脊柱融合手术。然而，关于此类患者的趋势和结果的信息很少。
方法
临床数据来自 2000 年至 2009 年的美国全国住院患者样本。确定了接受或未接受 SOT 并接受脊柱融合术的患者。检索并分析了与患者和医疗保健系统相关的特征、合并症、住院并发症和死亡率的数据。比较了有或没有 SOT 的患者的住院结果，并使用多变量逻辑回归进行了分析。
结果
在过去十年中，美国共有 5984 名 SOT 患者接受了脊柱融合术。从 2000 年到 2009 年，接受脊柱融合术的 SOT 患者的人口增长调整发病率增加了两倍多（2000 年为 0.102，每 10 万人，2009 年为 0.236，P<0.001）。比较有或没有 SOT 的患者发现，SOT 患者的总体住院并发症发生率（22.4%比 9.5%）和住院死亡率（1.3%比 0.3%）明显更高。0.7%的 SOT 脊柱融合患者发生移植物抗宿主病。SOT 患者发生尿路和肾脏并发症以及总体住院并发症的风险显著更高。
结论
在过去十年中，美国接受脊柱融合术的 SOT 患者的发病率有所增加。接受脊柱融合术的 SOT 患者的住院结果不如没有 SOT 的患者。
证据水平
3 级。
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