Smith Travis J, Bauer Amelia T, Kallies Kara J, Al-Hamadani Mohammed, Gundersen Sigurd B
WMJ. 2017 Feb;116(1):15-21.
Anterior exposure for spinal surgery has expanded and is used for common spinal procedures, including anterior lumbar interbody fusion, disc replacement, and vertebral corpectomy. With this approach, vascular injuries have been reported ranging from 1% to 25%. The impact of resident participation on intraoperative and postoperative outcomes within an independent academic medical center has not been widely reported. The objective of this study was to determine the incidence of complications during anterior exposure spinal surgery at an independent academic medical center.
After institutional review board approval, we conducted a retrospective review of medical records of patients who underwent elective anterior exposure for spinal surgery from 2000 through 2014.
The study included 335 patients; 60.3% were female. Thirty-day postoperative complications included surgical site infection (4.2%), urinary tract infection (2.7%), need for blood transfusion (2.1%), retrograde ejaculation (1.2%), and deep vein thrombosis (0.9%). There were 12 vascular injuries overall (3.6%); 2.7% were major vascular injuries. Surgery residents participated in 34% of cases. Resident involvement increased over the course of the study. There was no difference in operative time or complications with resident involvement.
The overall incidence of major vascular injury was 2.7%. Levels of exposure and blood loss were associated with vascular injury. Overall postoperative complication rates as well as major vascular injury rates compared favorably to published benchmarks. Complication rates were unaffected by surgical resident involvement.
脊柱手术的前路显露范围已扩大，常用于常见的脊柱手术，包括腰椎前路椎间融合术、椎间盘置换术和椎体次全切除术。采用这种手术方式，血管损伤的报告发生率在1%至25%之间。住院医师参与手术对独立学术医疗中心手术中及术后结果的影响尚未得到广泛报道。本研究的目的是确定在独立学术医疗中心进行脊柱前路显露手术时并发症的发生率。
经机构审查委员会批准后，我们对2000年至2014年接受择期脊柱前路显露手术患者的病历进行了回顾性研究。
该研究纳入了335例患者；其中60.3%为女性。术后30天的并发症包括手术部位感染（4.2%）、尿路感染（2.7%）、输血需求（2.1%）、逆行射精（1.2%）和深静脉血栓形成（0.9%）。总体共有12例血管损伤（3.6%）；其中2.7%为严重血管损伤。手术住院医师参与了34%的病例。在研究过程中，住院医师的参与度有所增加。住院医师参与与否在手术时间或并发症方面没有差异。
严重血管损伤的总体发生率为2.7%。显露程度和失血量与血管损伤有关。总体术后并发症发生率以及严重血管损伤发生率与已发表的基准相比情况良好。并发症发生率不受手术住院医师参与情况的影响。
