Segreto Frank A, Vasquez-Montes Dennis, Bortz Cole A, Horn Samantha R, Diebo Bassel G, Vira Shaleen, Kelly John J, Stekas Nicholas, Ge David H, Ihejirika Yael U, Lafage Renaud, Lafage Virginie, Karamitopoulos Mara, Delsole Edward M, Hockley Aaron, Petrizzo Anthony M, Buckland Aaron J, Errico Thomas J, Gerling Michael C, Passias Peter G
Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA.
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.
J Clin Neurosci. 2019 Apr;62:105-111. doi: 10.1016/j.jocn.2018.12.007. Epub 2019 Jan 8.
This study sought to assess comorbidity profiles unique to early-onset-scoliosis (EOS) patients by employing cluster analytics and to determine the influence of isolated comorbidity clusters on perioperative complications, morbidity and mortality using a high powered administrative database. The KID database was queried for ICD-9 codes pertaining to congenital and idiopathic scoliosis from 2003, 2006, 2009, 2012. Patients <10 y/o (EOS group) were included. Demographics, incidence and comorbidity profiles were assessed. Comorbidity profiles were stratified by body systems (neurological, musculoskeletal, pulmonary, cardiovascular, renal). K-means cluster and descriptive analyses elucidated incidence and comorbidity relationships between frequently co-occurring comorbidities. Binary logistic regression models determined predictors of perioperative complication development, mortality, and extended length-of-stay (≥75th percentile). 25,747 patients were included (Age: 4.34, Female: 52.1%, CCI: 0.64). Incidence was 8.9 per 100,000 annual discharges. 55.2% presented with pulmonary comorbidities, 48.7% musculoskeletal, 43.8% neurological, 18.6% cardiovascular, and 11.9% renal; 38% had concurrent neurological and pulmonary. Top inter-bodysystem clusters: Pulmonary disease (17.2%) with epilepsy (17.8%), pulmonary failure (12.2%), restrictive lung disease (10.5%), or microcephaly and quadriplegia (2.1%). Musculoskeletal comorbidities (48.7%) with renal and cardiovascular comorbidities (8.2%, OR: 7.9 [6.6-9.4], p < 0.001). Top intra-bodysystem clusters: Epilepsy (11.7%) with quadriplegia (25.8%) or microcephaly (20.5%). Regression analysis determined neurological and pulmonary clusters to have a higher odds of perioperative complication development (OR: 1.28 [1.19-1.37], p < 0.001) and mortality (OR: 2.05 [1.65-2.54], p < 0.001). Musculoskeletal with cardiovascular and renal anomalies had higher odds of mortality (OR: 1.72 [1.28-2.29], p < 0.001) and extLOS (OR: 2.83 [2.48-3.22], p < 0.001). EOS patients with musculoskeletal conditions were 7.9x more likely to have concurrent cardiovascular and renal anomalies. Clustered neurologic and pulmonary anomalies increased mortality risk by as much as 105%. These relationships may benefit pre-operative risk assessment for concurrent anomalies and adverse outcomes. Level of Evidence: III - Retrospective Prognostic Study.
本研究旨在通过聚类分析评估早发性脊柱侧弯（EOS）患者特有的共病谱，并使用一个强大的管理数据库确定孤立的共病簇对围手术期并发症、发病率和死亡率的影响。查询2003年、2006年、2009年、2012年KID数据库中与先天性和特发性脊柱侧弯相关的ICD - 9编码。纳入年龄＜10岁的患者（EOS组）。评估人口统计学、发病率和共病谱。共病谱按身体系统（神经、肌肉骨骼、肺、心血管、肾）分层。K均值聚类和描述性分析阐明了常见共病之间的发病率和共病关系。二元逻辑回归模型确定围手术期并发症发生、死亡率和延长住院时间（≥第75百分位数）的预测因素。共纳入25,747例患者（年龄：4.34岁，女性：52.1%，CCI：0.64）。年发病率为每100,000例出院患者中有8.9例。55.2%有肺部共病，48.7%有肌肉骨骼共病，43.8%有神经共病，18.6%有心血管共病，11.9%有肾脏共病；38%同时有神经和肺部共病。身体系统间的主要聚类：肺部疾病（17.2%）合并癫痫（17.8%）、肺衰竭（12.2%）、限制性肺病（10.5%）或小头畸形和四肢瘫痪（2.1%）。肌肉骨骼共病（48.7%）合并肾脏和心血管共病（8.2%，OR：7.9 [6.6 - 9.4]，p＜0.001）。身体系统内的主要聚类：癫痫（11.7%）合并四肢瘫痪（25.8%）或小头畸形（20.5%）。回归分析确定神经和肺部聚类发生围手术期并发症的几率更高（OR：1.28 [1.19 - 1.37]，p＜0.001）以及死亡率更高（OR：2.05 [1.65 - 2.54]，p＜0.001）。肌肉骨骼合并心血管和肾脏异常的患者死亡率更高（OR：1.72 [1.28 - 2.29]，p＜0.001）和延长住院时间的几率更高（OR：2.83 [2.48 - 3.22]，p＜0.001）。患有肌肉骨骼疾病的EOS患者同时出现心血管和肾脏异常的可能性高7.9倍。聚类的神经和肺部异常使死亡风险增加多达105%。这些关系可能有助于对并发异常和不良结局进行术前风险评估。证据级别：III - 回顾性预后研究。
