Still Megan E H, Venturini Sara, Vycheth Iv, Nang Sam, Vuthy Din, Park Kee B
University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia.
Department of Neurosurgery, Preah Kossamak Hospital, Phnom Penh, Cambodia; Leicester Medical School, University of Leicester, Leicester, United Kingdom.
World Neurosurg. 2019 Feb;122:e1172-e1180. doi: 10.1016/j.wneu.2018.11.014. Epub 2018 Nov 14.
Spine pathology is a common reason for admission to neurosurgical units in low- and middle-income countries (LMICs) and can have high morbidity rates from lack of specialized institutes. However, good surgical outcomes and quality-of-life scores have been reported in LMICs. This study details the complication rates and predictive factors from spine surgery at a large hospital in Cambodia, aiming to identify high-risk patients to improve surgeon understanding of these complications for improved pre-operative planning and patient counseling.
This is a retrospective review of patients admitted for spine conditions to Preah Kossamak Hospital in Phnom Penh, Cambodia (2013-2017). Univariate analysis was conducted on potential predictive factors; variables with P < 0.1 were entered into multivariate logistic regression models.
Seven hundred seventy-three patients were included. Forty-six patients had complications including wrong level surgery, hardware failure, and infection. On multivariate analysis, patients from the provinces of Kratie (P = 0.009) or Sihanoukville (P = 0.036), and those that delayed seeking care for more than 1 year after injury (P = 0.027), were significant predictive factors of postoperative complications, and American Spinal Injury Association grade A injury (P = 0.020) was a predictive factor of poor outcome.
Many factors play a role in spine surgery complications in LMICs, including limited access to intra-operative technology, low follow-up rates, and minimal physiotherapy and rehabilitation capabilities. Patients with long delays in presentation, American Spinal Injury Association grade A injuries, and lumbar-level surgery may be especially susceptible to complications and postoperative morbidity. Despite this, institutions have reported encouraging spine trauma outcomes, and spine surgeries are becoming more accepted and safe operations in many LMICs.
在低收入和中等收入国家（LMICs），脊柱疾病是神经外科病房收治患者的常见原因，由于缺乏专业机构，其发病率可能很高。然而，在低收入和中等收入国家已有良好手术效果及生活质量评分的报道。本研究详细阐述了柬埔寨一家大型医院脊柱手术的并发症发生率及预测因素，旨在识别高危患者，以提高外科医生对这些并发症的认识，从而改进术前规划和患者咨询。
这是一项对柬埔寨金边Preah Kossamak医院收治的脊柱疾病患者（2013 - 2017年）的回顾性研究。对潜在预测因素进行单因素分析；将P < 0.1的变量纳入多因素逻辑回归模型。
共纳入773例患者。46例患者出现并发症，包括手术节段错误、内固定失败和感染。多因素分析显示，来自桔井省（P = 0.009）或西哈努克市（P = 0.036）的患者，以及受伤后延迟就医超过1年的患者（P = 0.027）是术后并发症的显著预测因素，美国脊髓损伤协会（American Spinal Injury Association）A级损伤（P = 0.020）是预后不良的预测因素。
在低收入和中等收入国家，许多因素在脊柱手术并发症中起作用，包括术中技术获取有限、随访率低以及物理治疗和康复能力有限。就诊延迟时间长、美国脊髓损伤协会A级损伤以及腰椎手术的患者可能尤其易发生并发症和术后发病。尽管如此，一些机构报告了令人鼓舞的脊柱创伤治疗效果，并且在许多低收入和中等收入国家，脊柱手术正变得越来越被接受且手术安全性提高。
