Cheung Zoe B, Vig Khushdeep S, White Samuel J W, Lima Mauricio C, Hussain Awais K, Phan Kevin, Kim Jun S, Caridi John M, Cho Samuel K
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Royal College of Surgeons in Ireland, Dublin, Ireland.
Global Spine J. 2019 May;9(3):254-259. doi: 10.1177/2192568218780355. Epub 2018 Jun 13.
Retrospective cohort study.
To determine the effect of obesity (body mass index >30 kg/m) on perioperative morbidity and mortality after surgical decompression of spinal metastases.
The American College of Surgeons National Surgical Quality Improvement Program database is a large multicenter clinical registry that collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from hospitals nationwide. Current Procedural Terminology codes were used to query the database for adults who underwent decompression with laminectomy for treatment of metastatic spinal lesions between 2010 and 2014. Patients were separated into 2 cohorts based on the presence of absence of obesity. Univariate analysis and multivariate logistic regression analysis were used to analyze the effect of obesity on perioperative morbidity and mortality.
There was a significantly higher rate of venous thromboembolism (VTE; obese 6.6% vs nonobese 4.2%; = .01) and pulmonary complications (obese 2.6% vs nonobese 2.2%; = .046) in the obese group compared with the nonobese group. The nonobese group had prolonged hospitalization (obese 62.0% vs nonobese 69.0%; = .001) and a higher incidence of blood transfusions (obese 26.8% vs nonobese 34.2%; < .001). On multivariate analysis, obesity was found to be an independent risk factor for VTE (odds ratio = 1.75, confidence interval = 1.17-2.63, = .007).
Obese patients were predisposed to an elevated risk of VTE following laminectomy for spinal metastases. Early postoperative mobilization and a low threshold to evaluate for perioperative VTE are important in these patients in order to appropriately diagnose and treat these complications and minimize morbidity.
回顾性队列研究。
确定肥胖（体重指数>30kg/m²）对脊柱转移瘤手术减压围手术期发病率和死亡率的影响。
美国外科医师学会国家外科质量改进计划数据库是一个大型多中心临床登记处，收集全国医院的术前危险因素、术中变量以及术后30天的发病率和死亡率结果。使用当前手术操作术语代码在数据库中查询2010年至2014年间接受椎板切除术减压治疗转移性脊柱病变的成年人。根据是否存在肥胖将患者分为两组。采用单因素分析和多因素逻辑回归分析来分析肥胖对围手术期发病率和死亡率的影响。
与非肥胖组相比，肥胖组静脉血栓栓塞症（VTE；肥胖组6.6% vs非肥胖组4.2%；P = 0.01）和肺部并发症（肥胖组2.6% vs非肥胖组2.2%；P = 0.046）的发生率显著更高。非肥胖组住院时间延长（肥胖组62.0% vs非肥胖组69.0%；P = 0.001）且输血发生率更高（肥胖组26.8% vs非肥胖组34.2%；P < 0.001）。多因素分析发现，肥胖是VTE的独立危险因素（比值比 = 1.75，置信区间 = 1.17 - 2.63，P = 0.007）。
肥胖患者在接受脊柱转移瘤椎板切除术后发生VTE的风险升高。对于这些患者，术后早期活动以及对围手术期VTE进行低阈值评估对于适当诊断和治疗这些并发症以及将发病率降至最低很重要。
