Bhimani Abhiraj D, Denyer Steven, Esfahani Darian R, Zakrzewski Jack, Aguilar Tania M, Mehta Ankit I
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
World Neurosurg. 2018 Sep;117:e290-e299. doi: 10.1016/j.wneu.2018.06.014. Epub 2018 Jun 12.
Intradural extramedullary (IDEM) spinal cord tumors account for two-thirds of all intraspinal neoplasms. Surgery for IDEM tumors carries risks for many different complications, which to date have been poorly described and quantified. In this study, we better characterize risk factors and complications for IDEM tumors, stratifying patients by spinal cord level and malignancy.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to determine 30-day outcomes following surgery for IDEM tumors between 2005 and 2016. Patients with cervical, thoracic, and lumbar tumors were compared in terms of demographics, comorbidities, and postoperative complications. A similar analysis was performed comparing patients with benign and malignant tumors.
A total of 991 patients with IDEM tumors were identified in the cohort. The majority of tumors were thoracic (44.3%), followed by lumbar (35.4%) and cervical (20.3%). Only 6.3% of patients were readmitted within 30 days, 4.2% returned to the operating room, and 1.0% died. Significant associations were noted between spinal cord level and patient sex, age, functional status, American Society of Anesthesiologists (ASA) classification, prevalence of diabetes and hypertension, and risk of developing pneumonia. Benign and malignant tumors differed by patient sex, baseline ASA class, risk of return to the operating room, mortality, and likelihood of transfusion.
IDEM tumors are common and carry surgical risks, with different complication profiles for tumors at different spinal levels and degrees of malignancy. With definitive risk factors and outcomes, the ACS-NSQIP cohort provides a snapshot of national neurosurgery trends and outcomes in contemporary IDEM surgery.
硬脊膜内髓外（IDEM）脊髓肿瘤占所有脊髓肿瘤的三分之二。IDEM肿瘤手术存在多种不同并发症的风险，迄今为止，对这些并发症的描述和量化都很欠缺。在本研究中，我们更好地描述了IDEM肿瘤的风险因素和并发症，按脊髓节段和肿瘤恶性程度对患者进行分层。
查询美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，以确定2005年至2016年间IDEM肿瘤手术后的30天结局。比较颈椎、胸椎和腰椎肿瘤患者的人口统计学、合并症和术后并发症。对良性和恶性肿瘤患者进行了类似分析。
队列中总共识别出991例IDEM肿瘤患者。大多数肿瘤位于胸椎（44.3%），其次是腰椎（35.4%）和颈椎（20.3%）。只有6.3%的患者在30天内再次入院，4.2%返回手术室，1.0%死亡。脊髓节段与患者性别、年龄、功能状态、美国麻醉医师协会（ASA）分级、糖尿病和高血压患病率以及发生肺炎的风险之间存在显著关联。良性和恶性肿瘤在患者性别、基线ASA分级、返回手术室的风险、死亡率和输血可能性方面存在差异。
IDEM肿瘤很常见且具有手术风险，不同脊髓节段和恶性程度的肿瘤并发症情况不同。有了明确的风险因素和结局数据，ACS-NSQIP队列提供了当代IDEM手术中全国神经外科趋势和结局的概况。
