Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2019 May;125:e1069-e1073. doi: 10.1016/j.wneu.2019.01.247. Epub 2019 Feb 18.
Few studies have examined the outcomes of open reduction and internal fixation of vertebral fractures. The purpose of this study was to determine patient-related and surgery-related risk factors associated with 30-day postoperative mortality after open reduction and internal fixation (ORIF) of cervical, thoracic, and lumbar vertebral fractures.
This was a retrospective cohort study of data from the 2010-2014 ACS-NSQIP database. Adult patients who underwent ORIF of vertebral fractures in the cervical, thoracic, or lumbar spine were included. Patients were divided into 2 groups on the basis of the occurrence of 30-day postoperative mortality. A univariate analysis was performed to compare baseline patient characteristics, comorbidities, operative variables, and 30-day postoperative complications between the mortality and nonmortality groups. A subsequent multivariate regression analysis adjusting for patient and operative factors was then performed to identify independent risk factors for 30-day mortality.
A total of 900 patients who underwent vertebral ORIF were included. The overall 30-day postoperative mortality rate was 1.56%. The mortality group had a higher incidence of pneumonia, pulmonary complications, cardiac complications, blood transfusion, sepsis, and prolonged hospitalization. Multivariate regression analysis identified pulmonary comorbidity and diabetes as independent predictors of 30-day mortality following ORIF of vertebral fractures.
Pulmonary comorbidity and diabetes were found to be independent risk factors for 30-day mortality after ORIF of vertebral fractures. Recognizing these risk factors is important in preoperative risk stratification, perioperative care, and patient counseling.
鲜有研究探讨过切开复位内固定术（ORIF）治疗脊柱骨折的结果。本研究旨在确定与颈椎、胸椎和腰椎骨折的 ORIF 术后 30 天内死亡率相关的患者相关和手术相关的危险因素。
这是一项回顾性队列研究，数据来自 2010 年至 2014 年美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库。纳入接受颈椎、胸椎或腰椎骨折 ORIF 的成年患者。根据术后 30 天内死亡率，将患者分为两组。采用单变量分析比较死亡率组和非死亡率组之间的基线患者特征、合并症、手术变量和术后 30 天并发症。随后进行多变量回归分析，调整患者和手术因素，以确定术后 30 天死亡率的独立危险因素。
共纳入 900 例接受脊柱 ORIF 的患者。总体术后 30 天死亡率为 1.56%。死亡率组肺炎、肺部并发症、心脏并发症、输血、败血症和住院时间延长的发生率更高。多变量回归分析确定肺部合并症和糖尿病是 ORIF 治疗脊柱骨折后 30 天死亡率的独立预测因素。
肺部合并症和糖尿病是 ORIF 治疗脊柱骨折后 30 天死亡率的独立危险因素。在术前风险分层、围手术期护理和患者咨询中识别这些危险因素很重要。
