成人症状性腰椎侧弯指数手术后计划外再次手术的患病率及指征：美国国立卫生研究院资助的临床试验
Prevalence and Indications for Unplanned Reoperations Following Index Surgery in the Adult Symptomatic Lumbar Scoliosis NIH-Sponsored Clinical Trial.
作者信息
Crawford Charles H, Glassman Steven D, Carreon Leah Y, Shaffrey Christopher I, Koski Tyler R, Baldus Christine R, Bridwell Keith H
机构信息
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, USA.
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
出版信息
Spine Deform. 2018 Nov-Dec;6(6):741-744. doi: 10.1016/j.jspd.2018.04.006.
STUDY DESIGN
Longitudinal cohort.
OBJECTIVE
To report on the prevalence and indications for unplanned reoperations following index surgery in the Adult Symptomatic Lumbar Scoliosis NIH-sponsored Clinical Trial.
SUMMARY OF BACKGROUND DATA
Reoperation following adult spinal deformity surgery exposes the patient to additional surgical risk, increases the cost of care, and decreases the potential cost-effectiveness of the intervention. Accurate data regarding the prevalence and indication for reoperation will facilitate future efforts to minimize risk.
METHODS
A total of 153 patients underwent adult spinal deformity surgery as part of the observational, randomized, or crossover groups and were eligible for two-year follow-up. Reoperations were meticulously tracked as part of the National Institutes of Health (NIH)-mandated serious adverse event (SAE) reporting. The primary indication for reoperation was obtained from the treating surgeon's operative report.
RESULTS
Thirty-two patients had one reoperation, two patients underwent two reoperations, and three patients underwent three reoperations. A total of 45 reoperations were performed in 37 patients. Eleven patients (7%) underwent reoperation within 90 days of the index surgery: two for superficial wound dehiscence, three for radiculopathy with screw removal, and six for acute proximal junctional failure (PJF). Four patients underwent reoperation for PJF more than 90 days from index surgery. Twenty-six patients underwent 28 reoperations for rod fracture/pseudoarthrosis.
CONCLUSION
In a consecutive series of adult spinal deformity surgery patients with meticulous follow-up, 24% of patients required an unplanned reoperation. The most common indication for reoperation was rod fracture/pseudoarthrosis, which occurred from 9 months to 3.7 years following the index surgery and accounted for 62% (28/45) of the reoperations. The second most common indication for reoperation was PJF, which occurred from 1 month to 1.6 years following index surgery and accounted for 22% (10/45) of the reoperations. As these complications will likely increase with longer follow-up, efforts to lower the rates of these complications are warranted.
LEVEL OF EVIDENCE
Level II.
研究设计
纵向队列研究。
目的
报告在成人症状性腰椎侧弯国立卫生研究院赞助的临床试验中，初次手术后计划外再次手术的发生率及指征。
背景资料总结
成人脊柱畸形手术后再次手术会使患者面临额外的手术风险，增加护理成本，并降低干预措施的潜在成本效益。关于再次手术发生率和指征的准确数据将有助于未来降低风险的努力。
方法
共有153例患者接受了成人脊柱畸形手术，作为观察性、随机或交叉分组的一部分，并且符合两年随访条件。作为美国国立卫生研究院（NIH）规定的严重不良事件（SAE）报告的一部分，对再次手术进行了细致跟踪。再次手术的主要指征来自主刀医生的手术报告。
结果
32例患者进行了1次再次手术，2例患者进行了2次再次手术，3例患者进行了3次再次手术。37例患者共进行了45次再次手术。11例患者（7%）在初次手术后90天内进行了再次手术：2例因浅表伤口裂开，3例因神经根病伴螺钉取出，6例因急性近端交界性失败（PJF）。4例患者在初次手术后90天以上因PJF进行了再次手术。26例患者因棒材骨折/假关节进行了28次再次手术。
结论
在一系列连续且随访细致的成人脊柱畸形手术患者中，24%的患者需要进行计划外再次手术。再次手术最常见的指征是棒材骨折/假关节，发生在初次手术后9个月至3.7年，占再次手术的62%（28/45）。再次手术第二常见的指征是PJF，发生在初次手术后1个月至1.6年，占再次手术的22%（10/45）。由于随着随访时间延长这些并发症可能会增加，因此有必要努力降低这些并发症的发生率。
证据级别
二级。
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