Zakaria Hesham Mostafa, Bazydlo Michael, Schultz Lonni, Pahuta Markian A, Schwalb Jason M, Park Paul, Aleem Ilyas, Nerenz David R, Chang Victor
Departments of1Neurosurgery.
2Public Health Sciences, and.
J Neurosurg Spine. 2019 Feb 15;30(5):602-614. doi: 10.3171/2018.10.SPINE18666. Print 2019 May 1.
The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a statewide, multicenter quality improvement initiative. Using MSSIC data, the authors sought to identify 90-day adverse events and their associated risk factors (RFs) after cervical spine surgery.
A total of 8236 cervical spine surgery cases were analyzed. Multivariable generalized estimating equation regression models were constructed to identify RFs for adverse events; variables tested included age, sex, diabetes mellitus, disc herniation, foraminal stenosis, central stenosis, American Society of Anesthesiologists Physical Classification System (ASA) class > II, myelopathy, private insurance, anterior versus posterior approach, revision procedures, number of surgical levels, length of procedure, blood loss, preoperative ambulation, ambulation day of surgery, length of hospital stay, and discharge disposition.
Ninety days after cervical spine surgery, adverse events identified included radicular findings (11.6%), readmission (7.7%), dysphagia requiring dietary modification (feeding tube or nothing by mouth [NPO]) (6.4%), urinary retention (4.7%), urinary tract infection (2.2%), surgical site hematoma (1.1%), surgical site infection (0.9%), deep vein thrombosis (0.7%), pulmonary embolism (0.5%), neurogenic bowel/bladder (0.4%), myelopathy (0.4%), myocardial infarction (0.4%), wound dehiscence (0.2%), claudication (0.2%), and ileus (0.2%). RFs for dysphagia included anterior approach (p < 0.001), fusion procedures (p = 0.030), multiple-level surgery when considering anterior procedures only (p = 0.037), and surgery duration (p = 0.002). RFs for readmission included ASA class > II (p < 0.001), while preoperative ambulation (p = 0.001) and private insurance (p < 0.001) were protective. RFs for urinary retention included increasing age (p < 0.001) and male sex (p < 0.001), while anterior-approach surgery (p < 0.001), preoperative ambulation (p = 0.001), and ambulation day of surgery (p = 0.001) were protective. Preoperative ambulation (p = 0.010) and anterior approach (p = 0.002) were protective of radicular findings.
A multivariate analysis from a large, multicenter, prospective database identified the common adverse events after cervical spine surgery, along with their associated RFs. This information can lead to more informed surgeons and patients. The authors found that early mobilization after cervical spine surgery has the potential to significantly decrease adverse events.
密歇根脊柱手术改善协作组织（MSSIC）是一项全州范围的多中心质量改进计划。作者利用MSSIC数据，试图确定颈椎手术后90天内的不良事件及其相关危险因素（RFs）。
共分析了8236例颈椎手术病例。构建多变量广义估计方程回归模型以确定不良事件的危险因素；测试的变量包括年龄、性别、糖尿病、椎间盘突出、椎间孔狭窄、中央管狭窄、美国麻醉医师协会身体状况分类系统（ASA）分级>II、脊髓病、私人保险、前路与后路手术、翻修手术、手术节段数、手术时长、失血量、术前活动能力、手术日活动能力、住院时间和出院处置方式。
颈椎手术后90天内，确定的不良事件包括神经根症状（11.6%）、再次入院（7.7%）、需要调整饮食的吞咽困难（鼻饲管或禁食[NPO]）（6.4%）、尿潴留（4.7%）、尿路感染（2.2%）、手术部位血肿（1.1%）、手术部位感染（0.9%）、深静脉血栓形成（0.7%）、肺栓塞（0.5%）、神经源性肠道/膀胱功能障碍（0.4%）、脊髓病（0.4%）、心肌梗死（0.4%）、伤口裂开（0.2%）、跛行（0.2%）和肠梗阻（0.2%）。吞咽困难的危险因素包括前路手术（p<0.001）、融合手术（p=0.030）、仅考虑前路手术时多节段手术（p=0.037）和手术时长（p=0.002）。再次入院的危险因素包括ASA分级>II（p<0.001），而术前活动能力（p=0.001）和私人保险（p<0.001）具有保护作用。尿潴留的危险因素包括年龄增加（p<0.001）和男性（p<0.001），而前路手术（p<0.001）、术前活动能力（p=0.001）和手术日活动能力（p=0.001）具有保护作用。术前活动能力（p=0.010）和前路手术（p=0.002）对神经根症状具有保护作用。
一项来自大型、多中心、前瞻性数据库的多变量分析确定了颈椎手术后常见的不良事件及其相关危险因素。这些信息可以使外科医生和患者做出更明智的决策。作者发现颈椎手术后早期活动有可能显著减少不良事件。
