Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Spine (Phila Pa 1976). 2019 Feb 1;44(3):E187-E193. doi: 10.1097/BRS.0000000000002783.
A retrospective analysis of prospectively collected data.
The aim of this study was to determine the ability of Revised Cardiac Risk Index (RCRI) to predict adverse cardiac events following posterior lumbar decompression (PLD).
PLD is an increasingly common procedure used to treat a variety of degenerative spinal conditions. The RCRI is used to predict risk for cardiac events following noncardiac surgery. There is a paucity of literature that directly addresses the relationship between RCRI and outcomes following PLD, specifically, the discriminative ability of the RCRI to predict adverse postoperative cardiac events.
ACS-NSQIP was utilized to identify patients undergoing PLD from 2006 to 2014. Fifty-two thousand sixty-six patients met inclusion criteria. Multivariate and ROC analysis was utilized to identify associations between RCRI and postoperative complications.
Membership in the RCRI=1 cohort was a predictor for myocardial infarction (MI) [odds ratio (OR) = 3.3, P = 0.002] and cardiac arrest requiring cardiopulmonary resuscitation (CPR) (OR = 3.4, P = 0.013). Membership in the RCRI = 2 cohort was a predictor for MI (OR = 5.9, P = 0.001) and cardiac arrest requiring CPR (OR = 12.5), Membership in the RCRI = 3 cohort was a predictor for MI (OR = 24.9) and cardiac arrest requiring CPR (OR = 26.9, P = 0.006). RCRI had a good discriminative ability to predict both MI [area under the curve (AUC) = 0.876] and cardiac arrest requiring CPR (AUC = 0.855). The RCRI had a better discriminative ability to predict these outcomes that did ASA status, which had discriminative abilities of "fair" (AUC = 0.799) and "poor" (AUC = 0.674), respectively. P < 0.001 unless otherwise specified.
RCRI was predictive of cardiac events following PLD, and RCRI had a better discriminative ability to predict MI and cardiac arrest requiring CPR than did ASA status. Consideration of the RCRI as a component of preoperative surgical risk stratification can minimize patient morbidity and mortality. Studies such as this can allow for implementation of guidelines that better estimate the preoperative risk profile of surgical patients.
前瞻性收集数据的回顾性分析。
本研究旨在确定修订后的心脏风险指数（RCRI）在预测后路腰椎减压（PLD）后不良心脏事件中的能力。
PLD 是一种越来越常见的用于治疗各种退行性脊柱疾病的手术。RCRI 用于预测非心脏手术后心脏事件的风险。直接探讨 RCRI 与 PLD 后结果之间关系的文献很少，特别是 RCRI 预测术后不良心脏事件的能力。
利用 ACS-NSQIP 从 2006 年至 2014 年确定接受 PLD 的患者。52066 名患者符合纳入标准。利用多变量和 ROC 分析确定 RCRI 与术后并发症之间的关联。
RCRI=1 队列的成员是心肌梗死（MI）（优势比[OR] = 3.3，P = 0.002）和需要心肺复苏（CPR）的心脏骤停（OR = 3.4，P = 0.013）的预测因素。RCRI=2 队列的成员是 MI（OR = 5.9，P = 0.001）和需要 CPR 的心脏骤停（OR = 12.5）的预测因素。RCRI=3 队列的成员是 MI（OR = 24.9）和需要 CPR 的心脏骤停（OR = 26.9，P = 0.006）的预测因素。RCRI 对 MI（曲线下面积[AUC] = 0.876）和需要 CPR 的心脏骤停（AUC = 0.855）的预测具有良好的判别能力。RCRI 对这些结果的判别能力优于美国麻醉医师协会（ASA）状态，后者的判别能力为“中等”（AUC = 0.799）和“差”（AUC = 0.674）。除非另有说明，否则 P<0.001。
RCRI 可预测 PLD 后的心脏事件，并且 RCRI 对 MI 和需要 CPR 的心脏骤停的预测能力优于 ASA 状态。考虑将 RCRI 作为术前手术风险分层的一个组成部分可以最大程度地降低患者的发病率和死亡率。此类研究可以实施更好地估计手术患者术前风险概况的指南。
3 级。
