Klineberg Eric O, Passias Peter G, Poorman Gregory W, Jalai Cyrus M, Atanda Abiola, Worley Nancy, Horn Samantha, Sciubba Daniel M, Hamilton D Kojo, Burton Douglas C, Gupta Munish Chandra, Smith Justin S, Soroceanu Alexandra, Hart Robert A, Neuman Brian, Ames Christopher P, Schwab Frank J, Lafage Virginie
70083UC Davis Health System, Sacramento, CA, USA.
25061NYU Hospital for Joint Diseases, New York, NY, USA.
Global Spine J. 2020 Oct;10(7):896-907. doi: 10.1177/2192568220937473. Epub 2020 Jul 30.
Retrospective review of prospective database.
Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes.
Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores.
Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( < .001) and LOS ( = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( < .05).
The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.
对前瞻性数据库进行回顾性分析。
成人脊柱畸形（ASD）手术的并发症发生率差异很大，因为尚无公认的分类系统。我们的目的是确定并发症发生、轻微-严重并发症以及Clavien-Dindo并发症分类（Cc）对临床变量和患者报告结局的影响。
对具有完整基线数据和2年数据的手术ASD患者的并发症进行术中、围手术期（<6周）和术后（>6周）评估。主要结局指标是根据3种量表评估的并发症发生时间和严重程度：并发症存在情况（是/否）、轻微-严重程度以及Cc评分。次要结局是手术结局（估计失血量[EBL]、住院时间[LOS]、再次手术）和健康相关生活质量（HRQL）评分。单因素分析确定并发症的存在、类型和Cc分级对手术变量和HRQL评分的影响。
167例患者中，30.5%（n = 51）有术中并发症，48.5%（n = 81）有围手术期并发症，58.7%（n = 98）有术后并发症。术中主要并发症与EBL增加（<0.001）和LOS延长（=0.0092）相关。术后并发症的存在和术后主要并发症与再次手术相关（<0.001）。在2年时，围手术期主要并发症与更差的ODI、SF-36以及SRS活动和外观评分相关（<0.02）。围手术期Cc评分增加和术后并发症的存在是HRQL结局较差的最佳预测因素（<0.05）。
Cc量表在预测患者结局变化方面最有用；在2年时，围手术期Cc评分升高和有术后并发症的患者HRQL改善程度降低。术中和围手术期并发症与更差的短期手术和住院结局相关。
