Narain Ankur S, Hijji Fady Y, Haws Brittany E, Khechen Benjamin, Kudaravalli Krishna T, Yom Kelly H, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Int J Spine Surg. 2020 Jun 30;14(3):286-293. doi: 10.14444/7038. eCollection 2020 Jun.
Postoperative complications after anterior cervical discectomy and fusion (ACDF) have a significant impact on clinical outcomes and health care resource use. Identifying predictive factors for complications after ACDF may allow for the modification of care protocols to mitigate complication risk. The purpose of this study is to determine risk factors for the incidence of medical and surgical complications up to 2 years postoperatively after ACDF procedures.
A prospectively maintained surgical registry of patients who underwent primary, 1-2-level ACDF was retrospectively reviewed. The incidence of medical and surgical complications up to 2 years postoperatively was determined. Patients were classified according to demographic, comorbidity, and procedural characteristics. Bivariate Poisson regression with robust error variance was used to determine if an association existed between the incidence of medical or surgical complications and patient characteristics. A final multivariate model including all patient and procedural characteristics as controls was created using backwards, stepwise regression until only those variables with < .05 remained.
A total of 310 patients were included. Upon bivariate analysis, age >50 years was identified as a risk factor for medical complications after ACDF procedures. Additionally, bivariate analysis identified ageless Charlson comorbidity index ≥2, operative duration >60 minutes, and 2-level procedures as risk factors for surgical complications after ACDF. Upon multivariate analysis, age >50 years was identified as an independent risk factor for medical complications (relative risk [RR] = 3.6, = .005), while operative time >60 minutes was identified as an independent risk factor for surgical complications after ACDF (RR = 4.5, = .017).
The results of this study demonstrate that older age and longer operative time were independent risk factors for medical and surgical complications, respectively, following ACDF. Patients with these risk factors should be counseled regarding their increased risk of postoperative complications and should undergo more vigilant monitoring to aid in complication avoidance.
Surgeons should consider the elevated risk of postoperative complications in >50 years old patients and >60 min procedures.
颈椎前路椎间盘切除融合术（ACDF）后的术后并发症对临床疗效和医疗资源利用有重大影响。识别ACDF术后并发症的预测因素可能有助于修改护理方案以降低并发症风险。本研究的目的是确定ACDF术后长达2年的医疗和手术并发症发生率的风险因素。
对前瞻性维护的接受初次1-2节段ACDF手术患者的手术登记资料进行回顾性分析。确定术后长达2年的医疗和手术并发症发生率。根据人口统计学、合并症和手术特征对患者进行分类。采用具有稳健误差方差的双变量泊松回归分析来确定医疗或手术并发症发生率与患者特征之间是否存在关联。使用向后逐步回归创建一个最终的多变量模型，将所有患者和手术特征作为对照，直到仅保留P<0.05的变量。
共纳入310例患者。双变量分析显示，年龄>50岁是ACDF术后医疗并发症的一个风险因素。此外，双变量分析确定无年龄限制的Charlson合并症指数≥2、手术时间>60分钟和双节段手术是ACDF术后手术并发症的风险因素。多变量分析显示，年龄>50岁是医疗并发症的独立风险因素（相对风险[RR]=3.6，P=0.005），而手术时间>60分钟是ACDF术后手术并发症的独立风险因素（RR=4.5，P=0.017）。
本研究结果表明，年龄较大和手术时间较长分别是ACDF术后医疗和手术并发症的独立风险因素。应向具有这些风险因素的患者告知其术后并发症风险增加的情况，并应进行更密切的监测以帮助避免并发症。
3级。
外科医生应考虑50岁以上患者和手术时间>60分钟的手术术后并发症风险升高的情况。
