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1972例颈椎椎体次全切除患者的描述性分析及术后30天结果

Descriptive Analysis of 1972 Cervical Corpectomy Patients and 30-Day Postoperative Outcomes.

作者信息

Towner James E, Li Yan Icy, Pieters Thomas A, Li Yan Michael

机构信息

Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.

出版信息

Int J Spine Surg. 2020 Jun 30;14(3):412-417. doi: 10.14444/7054. eCollection 2020 Jun.

DOI:10.14444/7054
PMID:32699765
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7343259/
Abstract

BACKGROUND

There exists no large, multi-institutional analysis of patients undergoing cervical corpectomy for common degenerative spinal disease, including patient demographics and comorbidities as well as postoperative complications.

METHODS

Using Current Procedural Terminology and International Classification of Diseases codes, 1972 patients who underwent a cervical corpectomy for degenerative spinal disease were identified from the American College of Surgeons National Surgical Quality Improvement Program data sets from 2012 to 2015. A descriptive analysis of the patients who underwent the procedure as well as 30-day outcomes and adverse events were collected. Multivariate logistic regression models were used to determine the effect of any preoperative factors identified from a univariate logistic regression analysis (variables with < .10) of complications.

RESULTS

The total complication rate, defined as major or minor adverse event, mortality, unplanned readmission, unplanned reoperation, or admission >30 days, was 13.28%. The percentage of patients who had ≥1 major or minor adverse events was 5.02%. Several factors commonly associated with an increased risk of perioperative complications, including smoking and diabetes, were found not to be independently associated with complications in this cohort.

CONCLUSIONS

This study is the largest analysis of cervical corpectomies. The results of the multivariate analysis provide guidance on risk factors associated with perioperative complications. These data could help develop risk-appropriate strategies for minimizing the effects of certain preoperative factors on perioperative complications.

摘要

背景

对于因常见退行性脊柱疾病接受颈椎椎体次全切除术的患者,目前尚无大规模的多机构分析,包括患者人口统计学特征、合并症以及术后并发症。

方法

利用当前手术操作术语和国际疾病分类编码,从美国外科医师学会国家外科质量改进计划2012年至2015年的数据集中识别出1972例因退行性脊柱疾病接受颈椎椎体次全切除术的患者。收集了接受该手术患者的描述性分析以及30天的结局和不良事件。使用多变量逻辑回归模型来确定从并发症的单变量逻辑回归分析(P<0.10的变量)中识别出的任何术前因素的影响。

结果

总并发症发生率定义为严重或轻微不良事件、死亡率、计划外再入院、计划外再次手术或住院时间>30天,为13.28%。发生≥1次严重或轻微不良事件的患者百分比为5.02%。在该队列中,发现一些通常与围手术期并发症风险增加相关的因素,包括吸烟和糖尿病,与并发症并无独立关联。

结论

本研究是对颈椎椎体次全切除术规模最大的分析。多变量分析结果为围手术期并发症相关的风险因素提供了指导。这些数据有助于制定风险适宜的策略,以尽量减少某些术前因素对围手术期并发症的影响。

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本文引用的文献

1
Clinical Comparison of Surgical Constructs for Anterior Cervical Corpectomy and Fusion in Patients With Cervical Spondylotic Myelopathy or Ossified Posterior Longitudinal Ligament: A Systematic Review and Meta-Analysis.脊髓型颈椎病或后纵韧带骨化症患者前路颈椎椎体次全切除融合术手术结构的临床比较:一项系统评价和Meta分析
Clin Spine Surg. 2018 Jul;31(6):247-260. doi: 10.1097/BSD.0000000000000649.
2
Anterior Cervical Option to Manage Degenerative Cervical Myelopathy.治疗退行性颈椎脊髓病的前路颈椎手术方案
Neurosurg Clin N Am. 2018 Jan;29(1):83-89. doi: 10.1016/j.nec.2017.09.005.
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Incidence of C5 nerve root palsy after cervical surgery: A meta-analysis for last decade.颈椎手术后C5神经根麻痹的发生率:过去十年的荟萃分析
Medicine (Baltimore). 2017 Nov;96(45):e8560. doi: 10.1097/MD.0000000000008560.
4
Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy: A meta-analysis.多节段脊髓型颈椎病行颈椎前路椎间盘切除融合术与颈椎前路椎体次全切除融合术的Meta分析
Medicine (Baltimore). 2016 Dec;95(49):e5437. doi: 10.1097/MD.0000000000005437.
5
Anterior corpectomy versus posterior laminoplasty for the treatment of multilevel cervical myelopathy: A meta-analysis.前路椎体切除术与后路椎板成形术治疗多节段颈脊髓病的比较:一项荟萃分析。
Int J Surg. 2016 Nov;35:21-27. doi: 10.1016/j.ijsu.2016.09.008. Epub 2016 Sep 10.
6
Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005-2012.颈椎后路手术后手术部位感染的危险因素:对2005 - 2012年美国外科医师学会国家外科质量改进计划中5441例患者的分析
Spine J. 2016 Apr;16(4):504-9. doi: 10.1016/j.spinee.2015.12.009. Epub 2015 Dec 10.
7
Prevalence of C5 nerve root palsy after cervical decompressive surgery: a meta-analysis.颈椎减压手术后C5神经根麻痹的患病率:一项荟萃分析。
Eur Spine J. 2015 Dec;24(12):2724-34. doi: 10.1007/s00586-015-4186-5. Epub 2015 Aug 18.
8
Anterior cervical discectomy and fusion may be more effective than anterior cervical corpectomy and fusion for the treatment of cervical spondylotic myelopathy.对于脊髓型颈椎病的治疗,颈椎前路椎间盘切除融合术可能比颈椎前路椎体次全切除融合术更有效。
BMC Musculoskelet Disord. 2015 Feb 13;16:29. doi: 10.1186/s12891-015-0490-9.
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Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of multilevel cervical spondylotic myelopathy: systematic review and a meta-analysis.前路颈椎间盘切除融合术与前路颈椎椎体次全切除融合术治疗多节段脊髓型颈椎病的系统评价与Meta分析
Ther Clin Risk Manag. 2015 Jan 29;11:161-70. doi: 10.2147/TCRM.S72699. eCollection 2015.
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