Ayling Oliver G S, Ailon Tamir, Street John T, Dea Nicolas, McIntosh Greg, Abraham Edward, Jacobs W Bradly, Soroceanu Alex, Johnson Michael G, Paquet Jerome, Rasoulinejad Parham, Phan Phillipe, Yee Albert, Christie Sean, Nataraj Andrew, Glennie R Andrew, Hall Hamilton, Manson Neil, Rampersaud Y Raja, Thomas Kenneth, Fisher Charles G
Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, Canada.
Canadian Spine Society, Markdale, Canada.
Neurosurgery. 2021 Jan 13;88(2):420-427. doi: 10.1093/neuros/nyaa427.
Perioperative adverse events (AEs) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes.
To examine perioperative AEs and their impact on outcome after lumbar spine surgery.
A total of 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3, 12, and 24 mo postoperatively included the Owestry Disability Index (ODI), 12-Item Short-Form Health Survey (SF-12) Physical (PCS) and Mental (MCS) Component Summary scales, visual analog scale (VAS) leg and back, EuroQol-5D (EQ5D), and satisfaction.
AEs occurred in 767 (21.6%) patients, and 85 (2.4%) patients suffered major AEs. Patients with major AEs had worse ODI scores and did not reach minimum clinically important differences at 2 yr (no AE: 25.7 ± 19.2, major: 36.4 ± 19.1, P < .001). Major AEs were associated with worse ODI scores on multivariable linear regression (P = .011). PCS scores were lower after major AEs (43.8 ± 9.5, vs 37.7 ± 20.3, P = .002). On VAS leg and back and EQ5D, the 2-yr outcomes were significantly different between the major and no AE groups (<0.01), but these differences were small (VAS leg: 3.4 ± 3.0 vs 4.0 ± 3.3; VAS back: 3.5 ± 2.7 vs 4.5 ± 2.6; EQ5D: 0.75 ± 0.2 vs 0.64 ± 0.2). SF12 MCS scores were not different. Rates of satisfaction were lower after major AEs (no AE: 84.6%, major: 72.3%, P < .05).
Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing AEs.
围手术期不良事件（AE）会导致患者失望并增加费用。关于AE如何影响长期预后的数据很少。
研究腰椎手术后的围手术期AE及其对预后的影响。
对加拿大脊柱预后与研究网络中3556例连续接受腰椎退行性疾病手术的患者进行分析。使用经过验证的脊柱不良事件严重程度系统定义AE。术后3个月、12个月和24个月的预后指标包括Oswestry功能障碍指数（ODI）、12项简短健康调查问卷（SF-12）身体（PCS）和精神（MCS）成分汇总量表、视觉模拟量表（VAS）腿部和背部疼痛评分、欧洲五维健康量表（EQ-5D）以及满意度。
767例（21.6%）患者发生AE，85例（2.4%）患者发生严重AE。发生严重AE的患者ODI评分更差，且在2年时未达到最小临床重要差异（无AE：25.7±19.2，严重AE：36.4±19.1，P<.001）。多变量线性回归分析显示严重AE与较差的ODI评分相关（P=.011）。严重AE后PCS评分更低（43.8±9.5，对比37.7±20.3，P=.002）。在VAS腿部和背部疼痛评分以及EQ-5D方面，严重AE组和无AE组2年时的预后有显著差异（<0.01），但这些差异较小（VAS腿部：3.4±3.0对比4.0±3.3；VAS背部：3.5±2.7对比4.5±2.6；EQ-5D：0.75±0.2对比0.64±0.2）。SF-12 MCS评分无差异。严重AE后满意度更低（无AE：84.6%，严重AE：72.3%，P<.05）。
腰椎手术后的严重AE会导致更差的功能预后和更低的满意度。这凸显了实施旨在减少AE的策略的必要性。
