Minhas S V, Mazmudar A S, Patel A A
NYU Langone Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York, NY, USA.
Feinberg School of Medicine, Northwestern University, Department of Orthopaedic Surgery, Chicago, IL, USA.
Bone Joint J. 2017 Jun;99-B(6):824-828. doi: 10.1302/0301-620X.99B6.BJJ-2016-1149.R1.
Patients seeking cervical spine surgery are thought to be increasing in age, comorbidities and functional debilitation. The changing demographics of this population may significantly impact the outcomes of their care, specifically with regards to complications. In this study, our goals were to determine the rates of functionally dependent patients undergoing elective cervical spine procedures and to assess the effect of functional dependence on 30-day morbidity and mortality using a large, validated national cohort.
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program data files from 2006 to 2013 was conducted to identify patients undergoing common cervical spine procedures. Multivariate logistic regression models were generated to analyse the independent association of functional dependence with 30-day outcomes of interest.
Patients with lower functional status had significantly higher rates of medical comorbidities. Even after accounting for these comorbidities, type of procedure and pre-operative diagnosis, analyses demonstrated that functional dependence was independently associated with significantly increased odds of sepsis (odds ratio (OR) 5.04), pulmonary (OR 4.61), renal (OR 3.33) and cardiac complications (OR 4.35) as well as mortality (OR 11.08).
Spine surgeons should be aware of the inherent risks of these procedures with the functionally dependent patient population when deciding on whether to perform cervical spine surgery, delivering pre-operative patient counselling, and providing peri-operative management and surveillance. Cite this article: 2017;99-B:824-8.
寻求颈椎手术的患者年龄、合并症及功能衰退情况被认为呈上升趋势。该人群人口统计学特征的变化可能会显著影响其治疗结果，尤其是在并发症方面。在本研究中，我们的目标是确定接受择期颈椎手术的功能依赖患者的比例，并使用一个大型的、经过验证的全国队列来评估功能依赖对30天发病率和死亡率的影响。
对美国外科医师学会国家外科质量改进计划2006年至2013年的数据文件进行回顾性分析，以确定接受常见颈椎手术的患者。生成多变量逻辑回归模型，以分析功能依赖与感兴趣的30天结局之间的独立关联。
功能状态较低的患者合并症发生率显著更高。即使在考虑了这些合并症、手术类型和术前诊断之后，分析表明功能依赖与败血症（优势比（OR）5.04）、肺部（OR 4.61）、肾脏（OR 3.33）和心脏并发症（OR 4.35）以及死亡率（OR 11.08）的显著增加独立相关。
脊柱外科医生在决定是否进行颈椎手术、提供术前患者咨询以及提供围手术期管理和监测时，应意识到这些手术对于功能依赖患者群体的固有风险。引用本文：2017；99 - B：824 - 8。
