De la Garza Ramos Rafael, Nakhla Jonathan, Echt Murray, Gelfand Yaroslav, Scoco Aleka N, Kinon Merrit D, Yassari Reza
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Global Spine J. 2018 Aug;8(5):483-489. doi: 10.1177/2192568217739886. Epub 2018 Apr 26.
Retrospective study of a prospectively collected database.
To investigate the rate and risk factors for 30-day readmissions and reoperations after 3-column osteotomy (3CO).
The American College of Surgeons National Surgical Quality Improvement Program database (2012-2014) was reviewed. Inclusion criteria were adult patients who underwent 3CO. The rate of 30-day readmission/reoperation was examined, and the association between patient/operative characteristics and outcome was investigated via multivariate analysis.
There were 299 patients who underwent a 3CO for spinal deformity. The rate of 30-day readmission and reoperation was 11.0% and 8.4%, respectively; 7.7% of readmissions were related to the primary procedure and 3.3% were unrelated. The most common unique cause for readmission was wound infection in 27.2% of cases. Among reoperations, the most common unique indications were wound infection (20.0%) and implant-related complications (20.0%). On multivariate analysis, obesity (odds ratio [OR] = 2.96; 95% CI = 1.06-8.25; = .038), chronic obstructive pulmonary disease (OR = 20.8; 95% CI = 3.49-123.5; = .001), and fusion of 13 or more spinal levels were independent predictors of readmission (OR = 4.86; 95% CI = 1.21-19.5; = .025). On the other hand, independent predictors of reoperation included chronic obstructive pulmonary disease (OR = 6.33; 95% CI = 1.16-34.5; = .033) and chronic steroid use (OR = 6.69; 95% CI = 1.61-27.7; = .009).
Wound complications and short-term implant-related complications are important causes of readmission and/or reoperation after 3CO. Preoperative factors such as obesity, chronic lung disease, chronic steroid use, and long-segment fusion procedures may significantly increase the risk of 30-day morbidity following high-grade osteotomies.
对前瞻性收集的数据库进行回顾性研究。
调查三柱截骨术（3CO）后30天再入院和再次手术的发生率及危险因素。
回顾美国外科医师学会国家外科质量改进计划数据库（2012 - 2014年）。纳入标准为接受3CO的成年患者。检查30天再入院/再次手术的发生率，并通过多变量分析研究患者/手术特征与结果之间的关联。
有299例患者因脊柱畸形接受了3CO。30天再入院率和再次手术率分别为11.0%和8.4%；7.7%的再入院与初次手术相关，3.3%无关。再入院最常见的单一原因是伤口感染，占27.2%的病例。在再次手术中，最常见的单一指征是伤口感染（20.0%）和植入物相关并发症（20.0%）。多变量分析显示，肥胖（优势比[OR]=2.96；95%可信区间[CI]=1.06 - 8.25；P=.038）、慢性阻塞性肺疾病（OR = 20.8；95% CI = 3.49 - 123.5；P=.001）以及13个或更多脊柱节段融合是再入院的独立预测因素（OR = 4.86；95% CI = 1.21 - 19.5；P=.025）。另一方面，再次手术的独立预测因素包括慢性阻塞性肺疾病（OR = 6.33；95% CI = 1.16 - 34.5；P=.033）和长期使用类固醇（OR = 6.69；95% CI = 1.61 - 27.7；P=.009）。
伤口并发症和短期植入物相关并发症是3CO后再入院和/或再次手术的重要原因。肥胖、慢性肺病、长期使用类固醇以及长节段融合手术等术前因素可能显著增加高级别截骨术后30天发病的风险。
