Park Hyung-Ki, Park Su-Yeon, Lee Poong-Hhoon, Park Hye-Ran, Park Sukh-Que, Cho Sung-Jin, Chang Jae-Chil
Department of Neurosurgery, Soonchunhyang University Hospital, Seoul, Korea.
Department of Biostatistics, Soonchunhyang University Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2020 Nov;63(6):730-737. doi: 10.3340/jkns.2020.0007. Epub 2020 May 20.
Spinal degeneration is a progressive disease, worsening over time. Lumbar degenerative disease (LDD) is a major spinal disease in elderly patients. Surgical treatment is considered for medically intractable patients with LDD and reoperation after primary surgery is not uncommon. The surgical outcome is occasionally unpredictable because of comorbidities. In the present study, the relationship between comorbidities and the incidence of reoperation for LDD over time was determined.
The claims data of the health insurance national database were used to identify a cohort of patients who underwent spinal surgery for LDD in 2009. The patients were followed up until 2016. Medical comorbidity was assessed according to the Charlson comorbidity index (CCI). Cox proportional hazard regression modeling was used to identify significant differences in sex, surgery, age, causative disease, and comorbidity.
The study cohort included 78241 patients; 10328 patients (13.2%) underwent reoperation during the observation period. The reoperation rate was statistically higher (p<0.01) in males, patients 55-74 years and 65-74 years of age, and patients with decompression or discectomy. Significant association was found between increasing reoperation rate and CCI score (p<0.01). Based on multivariate analysis of comorbidities, the significantly higher reoperation rates were observed in patients with peripheral vascular disease, pulmonary lung disease, peptic ulcer, diabetes, and diabetes complications (p<0.01).
The study results indicate the reoperation rate for LDD is associated with patient comorbidities. The comorbidities identified in this study could be helpful in future LDD studies.
脊柱退变是一种进行性疾病，会随时间推移而恶化。腰椎退变性疾病（LDD）是老年患者的主要脊柱疾病。对于药物治疗难以奏效的LDD患者会考虑手术治疗，初次手术后再次手术的情况并不少见。由于存在合并症，手术结果有时难以预测。在本研究中，确定了合并症与LDD再次手术发生率随时间的关系。
使用健康保险国家数据库的理赔数据来确定2009年因LDD接受脊柱手术的一组患者。对这些患者进行随访直至2016年。根据Charlson合并症指数（CCI）评估医疗合并症。采用Cox比例风险回归模型来确定性别、手术、年龄、致病疾病和合并症方面的显著差异。
研究队列包括78241名患者；10328名患者（13.2%）在观察期内接受了再次手术。男性、55 - 74岁和65 - 74岁的患者以及接受减压或椎间盘切除术的患者再次手术率在统计学上更高（p<0.01）。发现再次手术率增加与CCI评分之间存在显著关联（p<0.01）。基于合并症的多变量分析，在外周血管疾病、肺部疾病、消化性溃疡、糖尿病和糖尿病并发症患者中观察到显著更高的再次手术率（p<0.01）。
研究结果表明LDD的再次手术率与患者合并症有关。本研究中确定的合并症可能有助于未来的LDD研究。
