Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Spine J. 2018 Oct;18(10):1815-1821. doi: 10.1016/j.spinee.2018.03.010. Epub 2018 Mar 19.
The incidence of postoperative complications after microendoscopic laminectomy (MEL) has not been compared with that after open laminectomy in a large study, so it is not clear whether MEL is a safer procedure.
The objective of this study was to compare postoperative morbidity and mortality following lumbar laminectomy between patients treated with MEL and with open laminectomy.
This is a retrospective cohort study with propensity score-matched analysis.
Data of patients who underwent elective spinal surgery between July 2010 and March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan.
Clinical outcomes included length of hospital stay, occurrence of major complications (cardiac events, respiratory complications, pulmonary embolism, stroke, and acute renal failure), surgical site infection (SSI), postoperative delirium, and in-hospital death.
Propensity score matching was performed to adjust for measured confounding factors, including patient age, sex, Charlson Comorbidity Index, body mass index, smoking status, blood transfusion, duration of anesthesia, number of operated disc levels, and type of hospital and hospital volumes. The clinical outcomes of one-to-one propensity-matched pairs of the MEL and the open laminectomy groups were compared.
Of 23,317 patients identified in the database, 1,536 underwent MEL (6.6%). By one-to-one propensity score matching, 1,536 pairs were selected. The distributions of patient backgrounds were closely balanced between the MEL and the open laminectomy groups. An analysis of 1,536 pairs revealed that there was a significantly lower incidence of major postoperative complications in those who underwent MEL (1.0% vs. 2.8% for open laminectomy, risk difference 1.8%, 95% confidence interval [CI] 0.9%-2.9%), SSI (0.5% vs. 1.6% for open laminectomy, risk difference 1.1%, 95% CI 0.4%-1.9%), and postoperative delirium (1.1% vs. 2.3% for open laminectomy, risk difference1.2%, 95% CI 0.3%-2.1%). The length of hospital stay was significantly shorter in those treated with MEL (12 days vs. 16 days for open laminectomy, p<.001). There was no significant difference in in-hospital mortality between the groups.
Patients who underwent MEL were significantly less likely to experience major postoperative complications and were less likely to develop SSI and postoperative delirium than those who underwent open laminectomy.
微创手术（MEL）后的术后并发症发生率尚未在大规模研究中与开放式椎板切除术（OL）进行比较，因此不清楚 MEL 是否是一种更安全的手术方法。
本研究旨在比较 MEL 和 OL 治疗腰椎板切除术患者的术后发病率和死亡率。
这是一项回顾性队列研究，采用倾向评分匹配分析。
从日本全国住院患者数据库诊断程序组合数据库中提取 2010 年 7 月至 2013 年 3 月期间接受择期脊柱手术的患者数据。
临床结局包括住院时间、主要并发症（心脏事件、呼吸并发症、肺栓塞、中风和急性肾衰竭）、手术部位感染（SSI）、术后谵妄和住院期间死亡。
采用倾向评分匹配来调整测量的混杂因素，包括患者年龄、性别、Charlson 合并症指数、体重指数、吸烟状态、输血、麻醉持续时间、手术节段数以及医院类型和医院容量。比较 MEL 和 OL 组一对一倾向匹配对的临床结局。
在数据库中确定的 23317 名患者中，有 1536 名接受了 MEL（6.6%）。通过一对一的倾向评分匹配，选择了 1536 对。MEL 和 OL 组患者的背景分布分布均匀。对 1536 对患者的分析表明，MEL 组术后主要并发症的发生率明显较低（MEL 为 1.0%，OL 为 2.8%，风险差异 1.8%，95%置信区间[CI]0.9%-2.9%），SSI（MEL 为 0.5%，OL 为 1.6%，风险差异 1.1%，95%CI 0.4%-1.9%）和术后谵妄（MEL 为 1.1%，OL 为 2.3%，风险差异 1.2%，95%CI 0.3%-2.1%）。MEL 治疗组的住院时间明显缩短（MEL 为 12 天，OL 为 16 天，p<.001）。两组之间的住院死亡率无显著差异。
与接受 OL 治疗的患者相比，接受 MEL 治疗的患者术后发生重大并发症的风险明显降低，发生 SSI 和术后谵妄的风险也明显降低。
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