Malik Azeem Tariq, Yu Elizabeth, Kim Jeffery, Khan Safdar N
Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States.
Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States.
Clin Neurol Neurosurg. 2019 May;180:106-110. doi: 10.1016/j.clineuro.2019.03.023. Epub 2019 Apr 1.
Current evidence, with regard to primary vs. revision spinal fusions in pediatric spine deformities, is limited to inpatient outcomes only. The current study aims to analyze and compare 30-day outcomes in pediatric spine deformity patients undergoing a primary vs. a revision posterior spinal fusion.
The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database was queried using Current Procedural Terminology (CPT) codes for patients undergoing posterior spinal fusions (22800, 22802 and 22804). Patients undergoing concurrent anterior fusion/combined fusion and anterior-only fusions were removed from the study. Revision spinal fusions were captured using CPT codes for re-insertion of spinal fixation device (22830), exploration of spinal fusions (22849), 22850 and 22852 (removal of posterior instrumentation).
Out of a total of 13,398 patients, 332 (2.5%) underwent a revision posterior spinal fusion and the remained underwent primary spinal fusion. Following adjustment for baseline clinical characteristics, patients undergoing revision posterior spinal fusions were at a higher risk of deep surgical site infections (OR 2.43 [95% CI 1.10-5.35]; p = 0.028), organ/space surgical site infections (OR 4.09 [1.19-14.04]; p = 0.025) and 30-day unplanned re-operations (OR 1.87 [95% CI 1.17-3.00].
Pediatric spine deformity patients undergoing revision spinal fusions are at a higher risk of experiencing wound-complications and subsequent unplanned re-operations within 30-days of surgery. Providers should promote careful wound-care and/or awareness among care-givers to minimize the risks and costs associated with these specific adverse outcomes.
目前关于小儿脊柱畸形初次与翻修脊柱融合术的证据仅限于住院治疗结果。本研究旨在分析和比较接受初次与翻修后路脊柱融合术的小儿脊柱畸形患者的30天结局。
使用当前手术操作术语（CPT）编码查询2012 - 2016年美国外科医师学会 - 国家外科质量改进计划（ACS - NSQIP）儿科数据库，以获取接受后路脊柱融合术（22800、22802和22804）的患者。接受同期前路融合/联合融合以及单纯前路融合的患者被排除在研究之外。翻修脊柱融合术通过用于重新插入脊柱固定装置（22830）、探查脊柱融合术（22849）、22850和22852（移除后路器械）的CPT编码来记录。
在总共13398例患者中，332例（2.5%）接受了翻修后路脊柱融合术，其余患者接受了初次脊柱融合术。在对基线临床特征进行调整后，接受翻修后路脊柱融合术的患者发生深部手术部位感染的风险更高（比值比2.43 [95%置信区间1.10 - 5.35]；p = 0.028）、器官/腔隙手术部位感染（比值比4.09 [1.19 - 14.04]；p = 0.025）以及30天内非计划再次手术（比值比1.87 [95%置信区间1.17 - 3.00]）。
接受翻修脊柱融合术的小儿脊柱畸形患者在术后30天内发生伤口并发症及随后非计划再次手术的风险更高。医疗服务提供者应促进对伤口的精心护理和/或提高护理人员的意识，以将与这些特定不良结局相关的风险和成本降至最低。
