Lau Darryl, Yee Timothy J, La Marca Frank, Patel Rakesh, Park Paul
*Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA Departments of †Neurosurgery ‡Orthopedic Surgery, University of Michigan, Ann Arbor, MI.
Clin Spine Surg. 2017 Oct;30(8):374-381. doi: 10.1097/BSD.0000000000000174.
Retrospective review of patients who underwent surgery for spinal metastasis between 2005 and 2011.
To assess the utility of the surgical Apgar score (SAS) in patients who underwent surgery for spinal metastasis.
Surgery for spinal metastasis can be associated with relatively high morbidity and mortality. Consequently, identifying patients at risk for major postoperative complications is important. Several studies have validated SAS for predicting 30-day complication risk.
SASs were calculated and patients stratified into 5 groups: scores 0-2, 3-4, 5-6, 7-8, 9-10 points. Multivariate logistic regression assessed whether SAS was an independent predictor of major complication 30 days after surgery. Multivariate analysis of covariance assessed whether SAS was independently associated with length of stay.
Ninety-seven patients with a variety of metastatic tumors were analyzed. There was no obvious trend in complication rates, or significant association between SAS and complication rate (P=0.413). Complication rates were 25.0% for SASs 0-2, 33.3% for 3-4, 18.4% for 5-6, 10.0% for 7-8, and 33.3% for 9-10 points. On multivariate analysis, SAS was not independently associated with complications; age above 65 years (odds ratio 4.19; 95% confidence interval, 1.31-52.27; P=0.028) and preoperative Karnofsky Performance Score of 10-40 (odds ratio 9.13; 95% confidence interval, 1.42-58.63; P=0.020) were associated with higher odds of complication. SASs 0-2 were an independent predictor of longer hospital stay (P=0.004).
Our findings suggest that SAS is not a significant predictor of major perioperative complications after spinal metastasis surgery; preoperative functional status and age are stronger predictors. The need continues for a preoperative scoring system to reliably predict risk for perioperative complications after spinal metastasis surgery.
对2005年至2011年间接受脊柱转移瘤手术的患者进行回顾性研究。
评估手术阿普加评分（SAS）在接受脊柱转移瘤手术患者中的应用价值。
脊柱转移瘤手术可能伴有相对较高的发病率和死亡率。因此，识别术后发生主要并发症的风险患者很重要。多项研究已验证SAS可用于预测30天并发症风险。
计算SAS评分，并将患者分为5组：评分0 - 2分、3 - 4分、5 - 6分、7 - 8分、9 - 10分。多因素逻辑回归分析评估SAS是否为术后30天主要并发症的独立预测因素。多因素协方差分析评估SAS是否与住院时间独立相关。
分析了97例患有各种转移性肿瘤的患者。并发症发生率无明显趋势，且SAS与并发症发生率之间无显著关联（P = 0.413）。SAS评分为0 - 2分的并发症发生率为25.0%，3 - 4分的为33.3%，5 - 6分的为18.4%，7 - 8分的为10.0%，9 - 10分的为33.3%。多因素分析显示，SAS与并发症无独立相关性；65岁以上（比值比4.19；95%置信区间，1.31 - 52.27；P = 0.028）以及术前卡氏功能状态评分10 - 40分（比值比9.13；95%置信区间，1.42 - 58.63；P = 0.020）与并发症发生几率较高相关。SAS评分为0 - 2分是住院时间延长的独立预测因素（P = 0.004）。
我们的研究结果表明，SAS不是脊柱转移瘤手术后围手术期主要并发症的重要预测因素；术前功能状态和年龄是更强的预测因素。仍需要一种术前评分系统来可靠地预测脊柱转移瘤手术后围手术期并发症的风险。
