超重青少年特发性脊柱侧凸（AIS）患者行后路脊柱融合术（PSF）的围手术期风险是否增加？374 例 AIS 患者的倾向评分匹配分析。
Do Overweight Adolescent Idiopathic Scoliosis (AIS) Patients Have an Increased Perioperative Risk for Posterior Spinal Fusion (PSF) Surgery?: A Propensity Score Matching Analysis of 374 AIS Patients.
机构信息
Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
出版信息
Spine (Phila Pa 1976). 2019 Mar 15;44(6):389-396. doi: 10.1097/BRS.0000000000002853.
STUDY DESIGN
A retrospective study.
OBJECTIVE
The aim of this study was to compare the perioperative outcome of posterior spinal fusion (PSF) between overweight (OW) adolescent idiopathic scoliosis (AIS) patients and the healthy-weight (HW) patients using propensity score matching analysis.
SUMMARY OF BACKGROUND DATA
Obesity was found to increase postoperative surgical complications compared with the nonobese group. In scoliosis correction surgery, association of OW and perioperative risks had been explored, but most studies were retrospective in nature.
METHODS
From 374 patients, two comparable groups were matched using propensity score matching analysis with one-to-one nearest neighbor matching and a caliper of 0.2. There were 46 HW and OW patients in each group. The main outcome measures were intraoperative blood loss, use of allogeneic blood transfusion, operative time, duration of hospital stay post-surgery, total patient-controlled analgesia (PCA) morphine usage, perioperative complications, side bending flexibility (SBF), and correction rate (%).
RESULTS
The mean age was 13.3 ± 1.7 and 13.2 ± 1.7 years for HW and OW groups, respectively. The majority of the patients were Lenke 1 curves; 32.6% (HW) and 26.1% (OW) with an average Cobb angle of 69.0 ± 19.1° and 68.8 ± 18.4° for each group, respectively. The two groups were comparable. The operation time was 145.2 ± 42.2 and 154.4 ± 48.3 minutes for HW and OW groups, respectively (P > 0.05). The intraoperative blood loss was almost similar in both groups; 955.1 ± 497.7 mL (HW group) and 1011.8 ± 552.7 mL (OW group) (P > 0.05). Total PCA morphine used was higher in OW group (30.4 ± 22.7 mg) than in the HW group (16.2 ± 11.3 mg). No complication was observed in HW group, while in OW group, one patient (2.2%) developed intraoperative seizure.
CONCLUSION
OW AIS patients (≥85th percentile) had similar mean operative time, intraoperative blood loss, allogeneic transfusion rate, length of stay, and perioperative complications compared with HW AIS patients.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
本研究旨在通过倾向评分匹配分析比较超重（OW）青少年特发性脊柱侧凸（AIS）患者与健康体重（HW）患者后路脊柱融合术（PSF）的围手术期结果。
背景资料概要
与非肥胖组相比，肥胖被发现会增加术后手术并发症。在脊柱侧弯矫正手术中，已经探讨了 OW 与围手术期风险的关系，但大多数研究都是回顾性的。
方法
从 374 名患者中，通过 1:1 最近邻匹配和 0.2 卡尺的倾向评分匹配分析匹配了两个可比组。每组有 46 名 HW 和 OW 患者。主要观察指标为术中失血量、异体输血、手术时间、术后住院时间、总患者自控镇痛（PCA）吗啡用量、围手术期并发症、侧弯曲灵活性（SBF）和矫正率（%）。
结果
HW 组和 OW 组的平均年龄分别为 13.3±1.7 岁和 13.2±1.7 岁。大多数患者为 Lenke 1 型曲线；32.6%（HW）和 26.1%（OW），每组平均 Cobb 角为 69.0±19.1°和 68.8±18.4°。两组具有可比性。手术时间分别为 HW 组 145.2±42.2 分钟和 OW 组 154.4±48.3 分钟（P＞0.05）。两组术中失血量相似；HW 组 955.1±497.7mL，OW 组 1011.8±552.7mL（P＞0.05）。HW 组 PCA 吗啡总用量为 30.4±22.7mg，OW 组为 30.4±22.7mg。HW 组无并发症，OW 组 1 例（2.2%）术中出现癫痫。
结论
与 HW AIS 患者相比，OW AIS 患者（≥第 85 百分位）的平均手术时间、术中失血量、异体输血率、住院时间和围手术期并发症相似。
证据水平
3 级。
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