Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan.
Spine (Phila Pa 1976). 2018 Apr 15;43(8):562-570. doi: 10.1097/BRS.0000000000002411.
A retrospective database study.
The aim of this study was to develop and validate a sliding scale for predicting perioperative complications associated with adult spinal deformity (ASD) surgery.
ASD surgery can have high perioperative complication rates, which is associated with increased morbidity and mortality.
Data on consecutive ASD patients undergoing posterior corrective surgery over a 6-year interval were collected from a prospective database. The patients' preoperative general condition, surgical status, and perioperative complications occurring within 30 days of surgery were analyzed and independent predictors were determined using multivariable logistic regression analysis. We made the sliding scale using cut-off values from receiver operating curve analysis and validated the performance of this model.
Three hundred four patients were included with a mean age of 62.9 years. One hundred eight patients (35.5%) were affected by at least one perioperative complication with a total of 195 perioperative complications, including neurological (12.8%), excessive blood loss (11.2%), delirium (11.2%), and infection (3.6%). Total independent predictors were age [odds ratio (OR): 1.042], operation time (OPT) (OR: 2.015), and estimated blood loss (EBL) (OR: 4.885) with cut-off values of approximately 70 years, 6 hours, and 2000 mL, respectively. Fusion of ≥10 segments (OR: 2.262), three-column osteotomy (OR: 1.860), current use of antihypertensive (OR: 2.595) and anticoagulant (OR: 7.013), and body mass index (OR: 1.160) were risk factors for neurological complications, infection, and deep vein thrombosis/pulmonary thrombosis. Our proposed sliding scale had a sensitivity of 91%, specificity of 58.1%, and the incidence of perioperative complication in the validation dataset was smaller than that without this scale (P ≤ 0.05).
Patients' age, current medication, and degenerative pathology might be independent preoperative as well as operative predictors. An age and comorbidities based sliding scale with classifications of OPT and EBL may be useful for risk prediction in ASD surgery.
回顾性数据库研究。
本研究旨在开发和验证用于预测成人脊柱畸形（ASD）手术相关围手术期并发症的滑动量表。
ASD 手术的围手术期并发症发生率较高，这与发病率和死亡率的增加有关。
从前瞻性数据库中收集了 6 年内接受后路矫正手术的连续 ASD 患者的数据。分析患者术前一般情况、手术状态以及术后 30 天内发生的围手术期并发症，并使用多变量逻辑回归分析确定独立预测因子。我们使用来自接收者操作曲线分析的截断值制作滑动量表，并验证该模型的性能。
共纳入 304 例患者，平均年龄为 62.9 岁。108 例（35.5%）患者至少发生 1 种围手术期并发症，共发生 195 种围手术期并发症，包括神经并发症（12.8%）、失血过多（11.2%）、谵妄（11.2%）和感染（3.6%）。总独立预测因子为年龄[比值比（OR）：1.042]、手术时间（OPT）（OR：2.015）和估计出血量（EBL）（OR：4.885），截断值分别约为 70 岁、6 小时和 2000 毫升。融合≥10 个节段（OR：2.262）、三柱截骨术（OR：1.860）、当前使用降压药（OR：2.595）和抗凝药（OR：7.013）以及体重指数（OR：1.160）是神经并发症、感染和深静脉血栓/肺血栓形成的危险因素。我们提出的滑动量表的敏感性为 91%，特异性为 58.1%，验证数据集中的围手术期并发症发生率低于没有该量表的情况（P≤0.05）。
患者的年龄、当前用药和退行性病变可能是独立的术前和手术预测因素。基于年龄和合并症的滑动量表，结合 OPT 和 EBL 的分类，可能有助于 ASD 手术的风险预测。
3 级
