老年人群腰椎和胸椎脊柱畸形手术相关并发症的患病率：一项荟萃分析。
The prevalence of complications associated with lumbar and thoracic spinal deformity surgery in the elderly population: a meta-analysis.
作者信息
Smith Colleen, Lamba Nayan, Ou Zhonghui, Vo Quynh-Anh, Araujo-Lama Lita, Lim Sanghee, Joshi Dhaivat, Doucette Joanne, Papatheodorou Stefania, Tafel Ian, Aglio Linda S, Smith Timothy R, Mekary Rania A, Zaidi Hasan
机构信息
Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, MA, USA.
Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
J Spine Surg. 2019 Jun;5(2):223-235. doi: 10.21037/jss.2019.03.06.
BACKGROUND
The prevalence of spinal deformities increases with age, affecting between 30% and 68% of the elderly population (ages ≥65). The reported prevalence of complications associated with surgery for spinal deformities in this population ranges between 37% and 71%. Given the wide range of reported complication rates, the decision to perform surgery remains controversial.
METHODS
A comprehensive search was conducted using PubMed, Embase, and Cochrane to identify studies reporting complications for spinal deformity surgery in the elderly population. Pooled prevalence estimates for individual complication types were calculated using the random-effects model.
RESULTS
Of 5,586 articles, 14 met inclusion criteria. Fourteen complication types were reported, with at least 2 studies for each complication with the following pooled prevalence: reoperation (prevalence 19%; 95% CI, 9-36%; 107 patients); hardware failure (11%; 95% CI, 5-25%; 52 patients); infection (7%; 95% CI, 4-12%; 262 patients); pseudarthrosis (6%; 95% CI, 3-12%; 149 patients); radiculopathy (6%; 95% CI, 1-33%; 116 patients); cardiovascular event (5%; 95% CI, 1-32%; 121 patients); neurological deficit (5%; 95% CI, 2-15%; 248 patients); deep vein thrombosis (3%; 95% CI, 1-7%; 230 patients); pulmonary embolism (3%; 95% CI, 1-7%; 210 patients); pneumonia (3%; 95% CI, 1-11%; 210 patients); cerebrovascular or stroke event (2%; 95% CI, 0-9%; 85 patients); death (2%; 95% CI, 1-9%; 113 patients); myocardial infarction (2%; 95% CI, 1-6%; 210 patients); and postoperative hemorrhage (1%; 95% CI, 0-10%; 85 patients).
CONCLUSIONS
Most complication types following spinal deformity surgery in the elderly had prevalence point estimates of <6%, while all were at least ≤19%. Additional studies are needed to further explore composite prevalence estimates and prevalence associated with traditional surgical approaches as compared to minimally-invasive procedures in the elderly.
背景
脊柱畸形的患病率随年龄增长而增加，影响30%至68%的老年人群（年龄≥65岁）。据报道，该人群脊柱畸形手术相关并发症的患病率在37%至71%之间。鉴于报道的并发症发生率范围广泛，手术决策仍存在争议。
方法
使用PubMed、Embase和Cochrane进行全面检索，以确定报告老年人群脊柱畸形手术并发症的研究。使用随机效应模型计算个体并发症类型的合并患病率估计值。
结果
在5586篇文章中，14篇符合纳入标准。报告了14种并发症类型，每种并发症至少有2项研究，其合并患病率如下：再次手术（患病率19%；95%CI，9 - 36%；107例患者）；内固定失败（11%；95%CI，5 - 25%；52例患者）；感染（7%；95%CI，4 - 12%；262例患者）；假关节形成（6%；95%CI，3 - 12%；149例患者）；神经根病（6%；95%CI，1 - 33%；116例患者）；心血管事件（5%；95%CI，1 - 32%；121例患者）；神经功能缺损（5%；95%CI，2 - 15%；248例患者）；深静脉血栓形成（3%；95%CI，1 - 7%；230例患者）；肺栓塞（3%；95%CI，1 - 7%；210例患者）；肺炎（3%；95%CI，1 - 11%；210例患者）；脑血管或中风事件（2%；95%CI，0 - 9%；85例患者）；死亡（2%；95%CI，1 - 9%；113例患者）；心肌梗死（2%；95%CI，1 - 6%；210例患者）；术后出血（1%；95%CI，0 - 10%；85例患者）。
结论
老年患者脊柱畸形手术后大多数并发症类型的患病率点估计值<6%，而所有并发症患病率均至少≤19%。需要进一步研究以进一步探讨合并患病率估计值以及与传统手术方法相比，老年患者微创手术相关的患病率。
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