Gvozdyev Borys V, Carreon Leah Y, Graves Christopher M, Riley Stephanie A, McGraw Katlyn E, Head R Joseph, Dimar John R, Glassman Steven D
Norton Leatherman Spine Center, Louisville.
University of Louisville School of Medicine; and.
J Neurosurg Spine. 2017 Oct;27(4):397-402. doi: 10.3171/2017.3.SPINE161400. Epub 2017 Jul 28.
OBJECTIVE Patient-reported outcomes (PROs) such as the Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) are widely used to evaluate treatment outcomes following spine surgery for degenerative conditions. The goal of this study was to use the Charlson Comorbidity Index (CCMI) as a measure of general health status, for comparison with standard PROs. METHODS The authors examined serial CCMI scores, complications, and PROs in 371 patients treated surgically for degenerative lumbar spine conditions who were enrolled in the Quality and Outcomes Database from a single center. The cohort included 152 males (41%) with a mean age of 58.7 years. Patients with no, minor, or major complications were compared at baseline and at 1 year postoperatively. RESULTS Minor complications were observed in 177 patients (48%), and major complications in 34 (9%). There were no significant differences in preoperative ODI, EQ-5D, or CCMI among the 3 groups. At 1 year, there was a significantly greater deterioration in CCMI in the major complication group (1.03) compared with the minor (0.66) and no complication groups (0.44, p < 0.006), but no significant difference in ODI or EQ-5D. CONCLUSIONS Despite equivalent improvements in PROs, patients with major complications actually had greater deterioration in their general health status, as evidenced by worse CCMI scores. Because CCMI is predictive of medical and surgical risk, patients who sustained a major complication now carry a greater likelihood of adverse outcomes with future interventions, including subsequent spine surgery. Although PRO scores are a key metric, they fail to adequately reflect the potential long-term impact of major perioperative complications.
目的 患者报告结局（PROs），如奥斯维斯特里功能障碍指数（ODI）和欧洲五维健康量表（EQ-5D），被广泛用于评估退行性疾病脊柱手术后的治疗效果。本研究的目的是使用查尔森合并症指数（CCMI）作为一般健康状况的衡量指标，与标准的PROs进行比较。方法 作者检查了371例因退行性腰椎疾病接受手术治疗的患者的连续CCMI评分、并发症和PROs，这些患者来自单一中心的质量与结局数据库。该队列包括152名男性（41%），平均年龄58.7岁。对无并发症、轻度并发症或重度并发症的患者在基线和术后1年进行比较。结果 177例患者（48%）出现轻度并发症，34例（9%）出现重度并发症。三组患者术前ODI、EQ-5D或CCMI无显著差异。术后1年，重度并发症组的CCMI恶化程度（1.03）显著高于轻度并发症组（0.66）和无并发症组（0.44，p<0.006），但ODI或EQ-5D无显著差异。结论 尽管PROs有同等程度的改善，但重度并发症患者的总体健康状况实际上恶化程度更大，CCMI评分更差证明了这一点。由于CCMI可预测医疗和手术风险，发生重度并发症的患者未来进行干预（包括后续脊柱手术）时出现不良结局的可能性更大。虽然PRO评分是一个关键指标，但它们未能充分反映围手术期重度并发症的潜在长期影响。
