Department of Anesthesiology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
World Neurosurg. 2019 Aug;128:e597-e602. doi: 10.1016/j.wneu.2019.04.216. Epub 2019 May 2.
Increased intra-abdominal pressure with prone positioning for spinal surgery is associated with intraoperative hemodynamic alterations and the potential for postoperative complications. This study investigated the incidence of postoperative acute kidney injury (AKI) in patients undergoing spine surgery on a Jackson spinal table or a Wilson frame.
A total of 1374 patients who underwent spine surgery were divided into 2 groups: Jackson spinal table (n = 598) and Wilson frame group (n = 776). After 1:1 propensity score matching, a final analysis was performed on 970 patients. The primary endpoint was a comparison of the incidence of AKI in the 2 groups.
After propensity score matching analysis, the mean ± standard deviations of spine surgery invasiveness index were 4.7 ± 3.5 and 2.1 ± 1.4 in patients with the Jackson spinal table and the Wilson frame, respectively (P < 0.001). Considering the differences in surgical invasiveness, operative time, estimated blood loss, and administration of packed red blood cells were higher in the Jackson spinal table group than in the Wilson frame group (P < 0.001). However, the incidence of AKI was less with the Jackson spinal table than with the Wilson frame (1.7% vs. 3.7%, 2.25 [0.978-5.175], P = 0.056), not reaching statistical significance.
This analysis showed that postoperative AKI in patients undergoing spine surgery in the prone position was not different with the Wilson frame than in the Jackson spinal table despite higher surgical severity, longer operative times, and more blood loss in the latter group. In spine surgery, the appropriate selection of prone positioning apparatus can potentially be an important consideration in reducing the risk of AKI.
脊柱手术中俯卧位会导致腹内压升高，与术中血流动力学改变和术后并发症的发生有关。本研究旨在探讨在 Jackson 脊柱手术台或 Wilson 手术架上进行脊柱手术的患者术后发生急性肾损伤（AKI）的发生率。
共有 1374 例接受脊柱手术的患者被分为两组：Jackson 脊柱手术台组（n=598）和 Wilson 手术架组（n=776）。经过 1:1 倾向评分匹配后，对 970 例患者进行最终分析。主要终点是比较两组患者 AKI 的发生率。
经过倾向评分匹配分析，Jackson 脊柱手术台和 Wilson 手术架组的脊柱手术侵袭指数平均值±标准差分别为 4.7±3.5 和 2.1±1.4（P<0.001）。考虑到手术侵袭性的差异，Jackson 脊柱手术台组的手术时间、估计失血量和红细胞悬液的输注量均高于 Wilson 手术架组（P<0.001）。然而，Jackson 脊柱手术台组的 AKI 发生率低于 Wilson 手术架组（1.7%对 3.7%，2.25[0.978-5.175]，P=0.056），但差异无统计学意义。
尽管 Jackson 脊柱手术台组手术严重程度更高、手术时间更长、失血量更多，但本分析显示，在接受俯卧位脊柱手术的患者中，术后 AKI 的发生率与 Wilson 手术架无差异。在脊柱手术中，适当选择俯卧位设备可能是降低 AKI 风险的一个重要考虑因素。
