Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL.
Holy Cross Hospital, Orthopedic Research Institute, Ft. Lauderdale, FL.
Spine (Phila Pa 1976). 2019 Feb 15;44(4):E233-E238. doi: 10.1097/BRS.0000000000002820.
Retrospective review.
The aim of this study was to identify whether a concomitant diagnosis of fibromyalgia (FM) influences postoperative complications, readmission rates or cost following primary 1 to 2 level lumbar fusions in an elective setting.
Patients with FM often are limited by chronic lower back pain, many of whom will seek operative treatment. No previous study has evaluated whether patients with a concomitant diagnosis of FM have more complications following spine surgery.
Medicare data (2005-2014) from a national database was queried for patients who underwent primary 1 to 2 level posterolateral lumbar spine fusion for degenerative lumbar pathology. Thirty- and 90-day postoperative complication rates, readmission rates, and treatment costs were queried. To reduce confounding, FM patients were matched with a control cohort of non-FM patients using patient demographics, treatment modality, and comorbid conditions, and then analyzed by multivariable logistic regression.
Within the first 30-day postoperative, acute post hemorrhagic anemia (odds ratio [OR]: 2.58; P < 0.001) and readmission rates were significantly higher in FM patients compared to controls. There was no significant difference in wound related complications within first 30-days (0.19% vs. 0.23%; P = 0.520) or with length of stay (3.60 vs. 3.53 days; P = 0.08). Within 90-day postoperative, FM patients had higher rates of pneumonia (OR: 3.73; P < 0.001) and incurred 5.31% more in hospital charges reimbursed compared to the control cohort.
Primary 1 to 2 level lumbar fusions performed on FM patients have higher rates of postoperative anemia, pneumonia, cost of care, and readmission compared to match controls. FM patients and surgeons should be aware of these increased risks in an effort to control hospital costs and potential complications.
回顾性研究。
本研究旨在确定在选择性原发性 1 至 2 级腰椎融合术的情况下，纤维肌痛（FM）的并存诊断是否会影响术后并发症、再入院率或成本。
患有 FM 的患者通常会受到慢性下腰痛的限制，其中许多人将寻求手术治疗。以前没有研究评估过患有 FM 的患者在接受脊柱手术后是否会出现更多并发症。
从全国数据库中的 Medicare 数据（2005-2014 年）中查询了因退行性腰椎病变而行原发性 1 至 2 级后路腰椎融合术的患者。查询了术后 30 天和 90 天的并发症发生率、再入院率和治疗费用。为了减少混杂因素，使用患者人口统计学、治疗方式和合并症将 FM 患者与非 FM 患者的对照组进行匹配，然后通过多变量逻辑回归进行分析。
在术后 30 天内，FM 患者的急性术后出血性贫血（比值比 [OR]：2.58；P < 0.001）和再入院率明显高于对照组。在术后 30 天内，FM 患者的伤口相关并发症发生率没有显著差异（0.19%比 0.23%；P = 0.520）或住院时间（3.60 天比 3.53 天；P = 0.08）。在术后 90 天内，FM 患者肺炎发生率较高（OR：3.73；P < 0.001），与对照组相比，医疗费用报销增加了 5.31%。
与匹配对照组相比，原发性 1 至 2 级腰椎融合术治疗 FM 患者术后贫血、肺炎、治疗费用和再入院率较高。FM 患者和外科医生应意识到这些增加的风险，以控制医院成本和潜在并发症。
3 级。
