Bronheim Rachel S, Oermann Eric K, Bronheim David S, Caridi John M
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2018 Dec;120:e1175-e1184. doi: 10.1016/j.wneu.2018.09.028. Epub 2018 Sep 12.
The Revised Cardiac Risk Index (RCRI) was designed to predict risk for cardiac events after noncardiac surgery. However, there is a paucity of literature that directly addresses the relationship between RCRI and noncardiac outcomes after posterior lumbar decompression (PLD). The objective of this study is to determine the ability of RCRI to predict noncardiac adverse events after PLD.
The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients undergoing PLD from 2006 to 2014. Multivariate and receiver operating characteristic analysis was used to identify associations between RCRI and postoperative complications.
A total of 52,066 patients met the inclusion criteria. Membership in the RCRI=1 cohort independently predicted unplanned intubation, ventilation >48 hours, progressive renal insufficiency, acute renal failure, urinary tract infection (UTI), sepsis, septic shock, and readmission. Membership in the RCRI=2 cohort independently predicted for superficial surgical site infection, pneumonia, unplanned intubation, ventilation >48 hours, bleeding transfusion, progressive renal insufficiency, acute renal failure, UTI, sepsis, septic shock, and readmission. Membership in the RCRI=3 cohort independently predicted unplanned intubation (odds ratio [OR], 11.8), ventilation >48 hours (OR, 23.0), acute renal failure (OR, 84.5), and UTI (OR, 3.6). RCRI had a poor discriminative ability (DA) (area under the curve = 0.623), and American Society of Anesthesiologists status had a fair DA (area under the curve = 0.770) to predict a composite of noncardiac complications.
RCRI was predictive of a wide range of noncardiac complications after PLD but had a diminished DA to predict a composite of any noncardiac complication than did American Society of Anesthesiologists score. Consideration of the RCRI as a component of preoperative surgical risk stratification can minimize patient morbidity and mortality after lumbar decompression.
修订后的心脏风险指数（RCRI）旨在预测非心脏手术后心脏事件的风险。然而，直接探讨RCRI与后路腰椎减压术（PLD）后非心脏结局之间关系的文献较少。本研究的目的是确定RCRI预测PLD后非心脏不良事件的能力。
利用美国外科医师学会国家外科质量改进计划识别2006年至2014年接受PLD的患者。采用多变量和受试者工作特征分析来确定RCRI与术后并发症之间的关联。
共有52066例患者符合纳入标准。RCRI=1组独立预测了非计划插管、通气>48小时、进行性肾功能不全、急性肾衰竭、尿路感染（UTI）、脓毒症、感染性休克和再入院。RCRI=2组独立预测了浅表手术部位感染、肺炎、非计划插管、通气>48小时、出血输血、进行性肾功能不全、急性肾衰竭、UTI、脓毒症、感染性休克和再入院。RCRI=3组独立预测了非计划插管（比值比[OR]，11.8）、通气>48小时（OR，23.0）、急性肾衰竭（OR，84.5）和UTI（OR，3.6）。RCRI的鉴别能力（DA）较差（曲线下面积=0.623），而美国麻醉医师协会（ASA）分级的DA中等（曲线下面积=0.770），用于预测非心脏并发症的综合情况。
RCRI可预测PLD后多种非心脏并发症，但与ASA分级相比，其预测任何非心脏并发症综合情况的DA较低。将RCRI作为术前手术风险分层的一个组成部分进行考虑，可使腰椎减压术后患者的发病率和死亡率降至最低。
