Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St, HC4 - #5400A, Los Angeles, CA, 90033, USA.
Eur Spine J. 2019 Sep;28(9):2070-2076. doi: 10.1007/s00586-019-06072-4. Epub 2019 Jul 19.
As the population continues to age, the number of lumbar spine surgeries continues to increase. While there are many complications associated with lumbar surgeries, a myocardial infarction (MI) is a particularly devastating one. This complication is of considerable importance with mortality rates of postoperative MI documented between 26.5 and 70%. This study aimed to determine the relationship between lumbar surgeries, preoperative diagnoses (risk factors), and myocardial infarction.
Data from the Humana database (PearlDiver) were analyzed from 2007 to 2016. Patients undergoing lumbar spine surgeries were identified and stratified based on procedural approach, patient demographics, and preoperative risk factors. Each group was analyzed to determine the incidence and relative risk. Chi-square analysis was used to determine the significance.
A total of 105,505 patients who fit inclusion criteria were identified in the PearlDiver database between 2007 and 2016. A total of 644 patients (0.63%) experienced a postoperative myocardial infarction within 30 days of surgery. Patients undergoing fusion and non-fusion procedures showed significantly different rates of postoperative myocardial infarction (0.08% vs. 0.05%, p < 0.01). Male patients, older patients, and patients with a Charlson comorbidity index > 3 showed a considerable increase in incidence (p < 0.01). Furthermore, patients with preoperative risk factors (high cholesterol, obesity, depression, congestive heart failure, hypertension, and hypotension) exhibited risk ratios from 0.01 to 1.85 (p < 0.01).
Preoperative risk factors, patient demographics, and procedure type had a significant effect on the incidence of postoperative myocardial infarction. These slides can be retrieved under Electronic Supplementary Material.
随着人口老龄化的持续，腰椎手术的数量不断增加。虽然腰椎手术有许多并发症，但心肌梗死（MI）是一种特别严重的并发症。这种并发症非常重要，术后 MI 的死亡率有记录在 26.5%至 70%之间。本研究旨在确定腰椎手术、术前诊断（危险因素）和心肌梗死之间的关系。
对 2007 年至 2016 年期间 Humana 数据库（PearlDiver）的数据进行分析。确定接受腰椎手术的患者，并根据手术方法、患者人口统计学和术前危险因素进行分层。分析每个组以确定发病率和相对风险。使用卡方分析来确定显著性。
在 2007 年至 2016 年期间，PearlDiver 数据库中确定了符合纳入标准的 105505 名患者。共有 644 名患者（0.63%）在手术后 30 天内发生术后心肌梗死。接受融合和非融合手术的患者的术后心肌梗死发生率明显不同（0.08%比 0.05%，p<0.01）。男性患者、年龄较大的患者和 Charlson 合并症指数>3 的患者发病率显著增加（p<0.01）。此外，有术前危险因素（高胆固醇、肥胖、抑郁、充血性心力衰竭、高血压和低血压）的患者风险比为 0.01 至 1.85（p<0.01）。
术前危险因素、患者人口统计学和手术类型对术后心肌梗死的发生率有显著影响。这些幻灯片可以在电子补充材料中检索到。
