腰椎硬脊膜撕裂对并发症和成本的真正影响。
The True Effect of a Lumbar Dural Tear on Complications and Cost.
机构信息
Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.
出版信息
Spine (Phila Pa 1976). 2020 Feb 1;45(3):E155-E162. doi: 10.1097/BRS.0000000000003213.
STUDY DESIGN
Retrospective database analysis.
OBJECTIVE
The aim of this study was to match risk factors for complications in patients who did and did not sustain a dural tear while undergoing posterior lumbar spine surgery and compare local and systemic complications.
SUMMARY OF BACKGROUND DATA
Current data do not adequately define whether the event of sustaining an isolated dural tear increases the risk for postoperative complications while controlling for other confounding risk factors.
METHODS
The PearlDiver Database was queried for patients who underwent posterior lumbar spine decompression and/or fusion for degenerative pathology. Patients with and without dural tears were 1:2 matched based on demographic variables and comorbidities. Complications, cost, length of stay (LOS), and readmission rates were analyzed.
RESULTS
The 1:2 matched cohort included 9038 patients with a dural tear and 17,340 patients without a dural tear. All complications assessed were significantly higher in the dural tear group (P < 0.03). Venothromboembolic (VTE) events occurred in 1.3% of patients with a dural tear and 0.9% of patients without a dural tear (odds ratio [OR] 1.46, P < 0.0001). Meningitis occurred in 25 patients (0.3%) with a dural tear and eight patients (<0.1%) without a dural tear (OR 6.0, P < 0.0001). Patients with a dural tear had 120% higher medical costs, 200% greater LOS, and were two times more likely to be readmitted (P < 0.0001).
CONCLUSION
Sustaining a dural tear while undergoing posterior lumbar spinal decompression and/or fusion for degenerative pathology significantly increased the risk of complications and increased length of stay, risk of readmission, and overall 90-day hospital cost. Dural tears specifically increased the risk of a VTE complication by 1.46 times and meningitis by six times; these are important complications to have a high degree of suspicion for in the setting of durotomy, as they can lead to significant morbidity for the patient.
LEVEL OF EVIDENCE
研究设计
回顾性数据库分析。
目的
本研究旨在比较并匹配行后路腰椎脊柱手术时发生和未发生硬脊膜撕裂的患者的并发症风险因素，并比较局部和全身并发症。
背景数据概要
目前的数据不能充分定义在控制其他混杂风险因素的情况下，发生孤立性硬脊膜撕裂是否会增加术后并发症的风险。
方法
通过 PearlDiver 数据库查询接受后路腰椎脊柱减压和/或融合治疗退行性病变的患者。根据人口统计学变量和合并症，将有和无硬脊膜撕裂的患者以 1:2 匹配。分析并发症、成本、住院时间（LOS）和再入院率。
结果
1:2 匹配队列包括 9038 例硬脊膜撕裂患者和 17340 例无硬脊膜撕裂患者。硬脊膜撕裂组的所有评估并发症均显著更高（P<0.03）。硬脊膜撕裂患者中静脉血栓栓塞（VTE）事件发生率为 1.3%，无硬脊膜撕裂患者中发生率为 0.9%（比值比[OR]1.46，P<0.0001）。硬脊膜撕裂患者中有 25 例（0.3%）发生脑膜炎，无硬脊膜撕裂患者中有 8 例（<0.1%）发生脑膜炎（OR6.0，P<0.0001）。硬脊膜撕裂患者的医疗费用增加了 120%，住院时间延长了 200%，再入院的可能性增加了两倍（P<0.0001）。
结论
在行后路腰椎脊柱减压和/或融合治疗退行性病变时发生硬脊膜撕裂，显著增加了并发症风险，延长了住院时间，增加了再入院风险，并增加了 90 天住院总费用。硬脊膜撕裂特别使 VTE 并发症的风险增加了 1.46 倍，使脑膜炎的风险增加了 6 倍；在硬脊膜切开术的情况下，这些并发症非常重要，应高度怀疑，因为它们会给患者带来严重的发病率。
证据等级
3。
Zotero 插件