Kessler Remi A, De la Garza Ramos Rafael, Purvis Taylor E, Ahmed A Karim, Goodwin C Rory, Sciubba Daniel M, Abd-El-Barr Muhammad M
Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States.
Clin Neurol Neurosurg. 2018 Jun;169:161-165. doi: 10.1016/j.clineuro.2018.04.014. Epub 2018 Apr 9.
It is well-documented that geriatric patients are at risk for serious injuries after fracture due to pre-existing medical conditions, physical changes of aging, and medication effects. Frailty has been demonstrated to be a predictor of morbidity and mortality in inpatient head and neck surgery, and for surgical intervention for adult spinal deformity and degenerative spine disease. However, the impact of frailty on complications following thoracolumbar/thoracic fractures are unknown and has not been previously assessed in the literature, particularly in a nationwide setting.
This was a retrospective study of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database for the years 2007 through 2012. Patients who underwent spinal decompression (+/- fusion) or an alternative intervention, defined as vertebroplasty or kyphoplasty (VP/KP) for thoracic or thoracolumbar fracture were identified. Frailty status was determined using a modified frailty index from the Canadian Study of Health and Aging Frailty Index, with frailty defined as a score = 0.27. 30-day morbidity and mortality were compared between frail and non-frail patients in each treatment group.
A total of 303 patients were included in this study. Of these, 38% of patients had VP/KP and 62% underwent surgery. Within the VP/KP cohort, 26% were frail. The proportion of these patients who developed at least one complication was 3.3% versus 3.6% for non-frail patients (p = 1.0). The 30-day mortality for frail versus not frail patients in this cohort was 0% versus 2.4% (p = 1.0). Among the surgical group, 13% were frail. In contrast, the likelihood of complications was 33.3% among frail patients and 4.2% for non-frail patients (p < 0.001). Frail patients also had a 16.7% 30-day mortality rate as compared to 0.6% in the non-frail group (p = 0.001). When comparing the frail versus non-frail patients overall, frail patients had a complication rate of 16.7%, as opposed to 4.0% in non-frail patients.
Frailty and surgical intervention are correlated with a higher 30-day complication rate in patients with thoracic and thoracolumbar fracture. This finding is an important consideration for surgical decision-making and patient counseling on treatment options.
有充分文献记载，老年患者由于既往存在的医疗状况、衰老导致的身体变化以及药物作用，骨折后有遭受严重损伤的风险。衰弱已被证明是住院头颈外科手术、成人脊柱畸形和退行性脊柱疾病手术干预中发病和死亡的预测指标。然而，衰弱对胸腰椎/胸椎骨折后并发症的影响尚不清楚，且此前尚未在文献中进行评估，尤其是在全国范围内。
这是一项对2007年至2012年前瞻性收集的美国外科医师学会国家外科质量改进数据库进行的回顾性研究。确定了接受脊柱减压（±融合）或替代干预（定义为胸椎或胸腰椎骨折的椎体成形术或后凸成形术（VP/KP））的患者。使用来自加拿大健康与衰老衰弱指数研究的改良衰弱指数确定衰弱状态，衰弱定义为得分≥0.27。比较了每个治疗组中衰弱和非衰弱患者的30天发病率和死亡率。
本研究共纳入303例患者。其中，38%的患者接受了VP/KP，62%接受了手术。在VP/KP队列中，26%为衰弱患者。这些患者中发生至少一种并发症的比例为3.3%，而非衰弱患者为3.6%（p = 1.0）。该队列中衰弱与非衰弱患者的30天死亡率分别为0%和2.4%（p = 1.0）。在手术组中，13%为衰弱患者。相比之下，衰弱患者发生并发症的可能性为33.3%，而非衰弱患者为4.2%（p < 0.001）。衰弱患者的30天死亡率为16.7%，而非衰弱组为0.6%（p = 0.001）。总体比较衰弱与非衰弱患者时，衰弱患者的并发症发生率为16.7%，而非衰弱患者为4.0%。
衰弱和手术干预与胸腰椎骨折患者较高的30天并发症发生率相关。这一发现是手术决策和患者治疗选择咨询中的重要考虑因素。
