Horn Samantha R, Pierce Katherine E, Oh Cheongeun, Segreto Frank A, Egers Max, Bortz Cole, Vasquez-Montes Dennis, Lafage Renaud, Lafage Virginie, Vira Shaleen, Steinmetz Leah, Ge David H, Buza John A, Moon John, Diebo Bassel G, Alas Haddy, Brown Avery E, Shepard Nicholas A, Hassanzadeh Hamid, Passias Peter G
NYU Medical Center, NY Spine Institute, New York, NY, USA.
NYU Langone Orthopaedic Hospital, New York, NY, USA.
Global Spine J. 2019 Oct;9(7):717-723. doi: 10.1177/2192568219826083. Epub 2019 Feb 5.
Retrospective review of a prospectively collected database.
To predict the occurrence of hospital-acquired conditions (HACs) 30-days postoperatively and to compare predictors of HACs for spine surgery with other common elective surgeries.
Patients ≥18 years undergoing elective spine surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2013. Outcome measures included any HACs: superficial or deep surgical site infection (SSI), venous thromboembolism (VTE), urinary tract infection (UTI). Spine surgery patients were compared with those undergoing other common procedures. Random forest followed by multivariable regression analysis was used to determine risk factors for the occurrence of HACs.
A total of 90 551 elective spine surgery patients, of whom 3021 (3.3%) developed at least 1 HAC, 1.4% SSI, 1.3% UTI, and 0.8% VTE. The occurrence of HACs for spine patients was predicted with high accuracy (area under the curve [AUC] 77.7%) with the following variables: female sex, baseline functional status, hypertension, history of transient ischemic attack (TIA), quadriplegia, steroid use, preoperative bleeding disorders, American Society of Anesthesiologists (ASA) class, operating room duration, operative time, and level of residency supervision. Functional status and hypertension were HAC predictors for total knee arthroplasty (TKA), bariatric, and cardiothoracic patients. ASA class and operative time were predictors for most surgery cohorts. History of TIA, preoperative bleeding disorders, and steroid use were less predictive for most other common surgical cohorts.
Occurrence of HACs after spine surgery can be predicted with demographic, clinical, and surgical factors. Predictors for HACs in surgical spine patients, also common across other surgical groups, include functional status, hypertension, and operative time. Understanding the baseline patient risks for HACs will allow surgeons to become more effective in their patient selection for surgery.
对前瞻性收集的数据库进行回顾性分析。
预测术后30天内医院获得性疾病（HACs）的发生情况，并比较脊柱手术与其他常见择期手术中HACs的预测因素。
在2005年至2013年美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库中识别年龄≥18岁接受择期脊柱手术的患者。结局指标包括任何HACs：表浅或深部手术部位感染（SSI）、静脉血栓栓塞（VTE）、尿路感染（UTI）。将脊柱手术患者与接受其他常见手术的患者进行比较。采用随机森林法随后进行多变量回归分析来确定HACs发生的危险因素。
共有90551例择期脊柱手术患者，其中3021例（3.3%）发生至少1种HACs，1.4%发生SSI，1.3%发生UTI，0.8%发生VTE。通过以下变量可高精度预测脊柱手术患者HACs的发生情况（曲线下面积[AUC]77.7%）：女性、基线功能状态、高血压、短暂性脑缺血发作（TIA）病史、四肢瘫痪、类固醇使用、术前出血性疾病、美国麻醉医师协会（ASA）分级、手术室时长、手术时间以及住院医师监督水平。功能状态和高血压是全膝关节置换术（TKA）、减肥手术和心胸外科手术患者HACs的预测因素。ASA分级和手术时间是大多数手术队列的预测因素。TIA病史、术前出血性疾病和类固醇使用对大多数其他常见手术队列的预测性较低。
脊柱手术后HACs的发生可通过人口统计学、临床和手术因素进行预测。脊柱手术患者HACs的预测因素在其他手术组中也较为常见，包括功能状态、高血压和手术时间。了解患者HACs的基线风险将使外科医生在手术患者选择方面更加有效。
