Li Xudong J, Lenke Lawrence G, Jin Li, Tuchman Alexander, Tan Lee A, Lehman Ronald A, Cerpa Meghan
Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, 22904, USA.
Department of Orthopedic Surgery, The Spine Hospital, Columbia University Medical Center, 650 West 168 Street, New York, NY, 10032, USA.
Spine Deform. 2020 Feb;8(1):97-104. doi: 10.1007/s43390-020-00047-y. Epub 2020 Jan 24.
Retrospective outcome analysis of a prospectively collected single-surgeon cases OBJECTIVES: Identify risk factors for complications in adult surgical spine deformity patients, develop a surgeon-specific risk stratification model, and predict the likelihood of 6-week postoperative complications based on prospectively collected preoperative measures. Adult spinal deformity surgery is challenging technically as well as economically. Although many risk factors are well known for spine surgery, complications after complex spine deformity surgery remain a significant problem worldwide.
We reviewed 124 consecutive adult patients who have undergone instrumented spinal fusion with nine or more levels over a 21-month period in a single institution. We extracted data from patient medical records. Complications within the 6 weeks after surgery were identified. Univariate and logistic regression analyses (LRAs) were implemented. We generated a formula based on the LRA predictive algorithm-a numeric probabilistic likelihood statistic representing an individual patient's risk of developing a complication.
A total of 34 (27%) patients had complications that were categorized into either 21 (17%) medical or 17 (13.7%) surgical complications, including 3 (2.4%) proximal junctional kyphosis, 8 (6.4%) neurologic deficit, and 9 (6.5%) any wound issue. The predictive model was significant and calibrated using area under the receiver operating characteristics curve analysis. The model correctly classified 83.1% cases. Patients with a three-column osteotomy or history of deep vein thrombosis have 6 and 19 times higher overall complications, respectively, compared with patients without. Patients with a three-column osteotomy or body mass index > 30, respectively, are 24 and 11 times more likely to develop a wound complication. Patients with a three-column osteotomy have 10 times higher rates of surgical complication.
Complex spine deformity is often associated with complications. No single variable effectively predicts postoperative complications for such a complicated situation. However, when all risk factors are considered, patients with three-column osteotomy have a significantly higher chance to develop early complications.
Level IV.
对前瞻性收集的单手术医生病例进行回顾性结果分析
确定成人脊柱畸形手术患者并发症的风险因素，建立特定于手术医生的风险分层模型，并根据前瞻性收集的术前指标预测术后6周并发症的可能性。成人脊柱畸形手术在技术和经济方面都具有挑战性。尽管脊柱手术的许多风险因素广为人知，但复杂脊柱畸形手术后的并发症在全球范围内仍然是一个重大问题。
我们回顾了在单一机构中21个月内连续接受9个或更多节段器械辅助脊柱融合术的124例成年患者。我们从患者病历中提取数据。确定术后6周内的并发症。进行单因素分析和逻辑回归分析（LRA）。我们基于LRA预测算法生成了一个公式——一个数字概率似然统计量，代表个体患者发生并发症的风险。
共有34例（27%）患者出现并发症，分为21例（17%）内科并发症或17例（13.7%）外科并发症，包括3例（2.4%）近端交界性后凸、8例（6.4%）神经功能缺损和9例（6.5%）任何伤口问题。使用受试者操作特征曲线分析下的面积对预测模型进行了显著性检验和校准。该模型正确分类了83.1%的病例。与无三柱截骨术或深静脉血栓形成病史的患者相比，有三柱截骨术或深静脉血栓形成病史的患者总体并发症发生率分别高出6倍和19倍。有三柱截骨术或体重指数>30的患者发生伤口并发症的可能性分别高出24倍和11倍。有三柱截骨术的患者手术并发症发生率高出10倍。
复杂脊柱畸形常伴有并发症。对于如此复杂的情况，没有单一变量能有效预测术后并发症。然而，当考虑所有风险因素时，行三柱截骨术的患者发生早期并发症的机会显著更高。
四级
