From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Mr. Bovonratwet, Mr. Malpani, Ms. Haynes, Dr. Rubio, Mr. Ondeck, Mr. Shultz, Mr. Mahal, and Dr. Grauer), and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, (Dr. Bohl).
J Am Acad Orthop Surg. 2019 Apr 1;27(7):256-263. doi: 10.5435/JAAOS-D-17-00650.
Large cohort studies evaluating cardiac complications in patients undergoing spine surgery are lacking. The purpose of this study was to determine the incidence, timing, risk factors, and effect of cardiac complications in spine surgery by using a national database, the American College of Surgeons National Surgical Quality Improvement Program.
Patients who underwent spine surgery in the 2005 to 2012 National Surgical Quality Improvement Program database were identified. The primary outcome was an occurrence of cardiac arrest or myocardial infarction during the operation or the 30-day postoperative period. Risk factors for development of cardiac complications were identified using multivariate regression. The postoperative length of stay, 30-day readmission, and mortality were compared between patients who did and did not experience a cardiac complication.
A total of 30,339 patients who underwent spine surgery were identified. The incidence of cardiac complications was 0.34% (95% confidence interval [CI], 0.27% to 0.40%). Of the cases in which a cardiac complication developed, 30% were diagnosed after discharge. Risk factors for the development of cardiac complications were greater age (most notably ≥80 years, relative risk [RR] = 5.53; 95% CI = 2.28 to 13.43; P < 0.001), insulin-dependent diabetes (RR = 2.58; 95% CI = 1.51 to 4.41; P = 0.002), preoperative anemia (RR = 2.46; 95% CI = 1.62 to 3.76; P < 0.001), and history of cardiac disorders and treatments (RR = 1.88; 95% CI = 1.16 to 3.07; P = 0.011). Development of a cardiac complication before discharge was associated with a greater length of stay (7.9 versus 2.6 days; P < 0.001), and a cardiac complication after discharge was associated with increased 30-day readmission (RR = 12.32; 95% CI = 8.17 to 18.59; P < 0.001). Development of a cardiac complication any time during the operation or 30-day postoperative period was associated with increased mortality (RR = 113.83; 95% CI = 58.72 to 220.68; P < 0.001).
Perioperative cardiac complications were diagnosed in approximately 1 in 300 patients undergoing spine surgery. High-risk patients should be medically optimized and closely monitored through the perioperative period.
Level III.
目前缺乏评估脊柱手术患者心脏并发症的大型队列研究。本研究的目的是通过使用国家数据库（美国外科医师学院国家手术质量改进计划）确定脊柱手术中心脏并发症的发生率、时间、危险因素和影响。
确定了 2005 年至 2012 年美国外科医师学院国家手术质量改进计划数据库中接受脊柱手术的患者。主要结果是手术期间或术后 30 天内发生心脏骤停或心肌梗死。使用多元回归确定发生心脏并发症的危险因素。比较发生和未发生心脏并发症患者的术后住院时间、30 天再入院和死亡率。
共确定了 30339 例接受脊柱手术的患者。心脏并发症的发生率为 0.34%（95%置信区间[CI]，0.27%至 0.40%）。发生心脏并发症的病例中，30%在出院后确诊。发生心脏并发症的危险因素是年龄较大（尤其是≥80 岁，相对风险[RR] = 5.53；95%CI = 2.28 至 13.43；P < 0.001）、胰岛素依赖型糖尿病（RR = 2.58；95%CI = 1.51 至 4.41；P = 0.002）、术前贫血（RR = 2.46；95%CI = 1.62 至 3.76；P < 0.001）和心脏疾病和治疗史（RR = 1.88；95%CI = 1.16 至 3.07；P = 0.011）。出院前发生心脏并发症与住院时间延长有关（7.9 天与 2.6 天；P < 0.001），出院后发生心脏并发症与 30 天再入院率增加有关（RR = 12.32；95%CI = 8.17 至 18.59；P < 0.001）。在手术或术后 30 天期间任何时间发生心脏并发症与死亡率增加相关（RR = 113.83；95%CI = 58.72 至 220.68；P < 0.001）。
约每 300 例接受脊柱手术的患者中就有 1 例被诊断为围手术期心脏并发症。高危患者应在围手术期进行医学优化，并密切监测。
III 级。
