School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Clin Neurol Neurosurg. 2020 Dec;199:106308. doi: 10.1016/j.clineuro.2020.106308. Epub 2020 Oct 14.
Chronic opioid use (COU) remains on the rise globally, acting as a marker for patient morbidity and a risk factor for adverse health outcomes. Opioid use is a risk factor for respiratory depression, which may lead to dysfunctional breathing, a known cause of atelectasis. The objective of this study was to determine whether COU is associated with increased rates of postoperative atelectasis among patients undergoing lumbar fusion.
MATERIALS & METHODS: Three State Inpatient Databases were used to identify patients who underwent an elective lumbar fusion through an anterior, posterior or circumferential approach in Florida, Kentucky and New York between 2013-2015. Patients with COU and those with postoperative atelectasis were identified using ICD diagnosis codes. Three operative groups were created and subsequently matched using propensity scores in order to provide comparable cohorts for analysis. Three-to-one propensity score matching was conducted using the variables of age, sex, race, number of chronic diagnoses and geographic state of admission. Multivariable logistic regressions were used to examine the relationship between COU and postoperative atelectasis.
A total of 3618 lumbar fusions were identified. Atelectasis was noted in 1.33 % of NCOU patients and 2.32 % of COU patients. On multivariable analysis, while controlling for the Elixhauser Mortality Index and patient insurance status, COU was significantly associated with atelectasis in posterior lumbar fusion (OR = 2.27; CI: 1.09-4.72; p = 0.028) and circumferential lumbar fusion (OR = 4.68; CI: 1.52-14.45; p = 0.007). The Elixhauser Mortality Index was also significantly associated with atelectasis in posterior lumbar fusion (OR = 1.08; CI: 1.04-1.11; p < 0.001) and circumferential lumbar fusion (OR = 1.09; CI: 1.03-1.16; p = 0.002).
Higher rates of postoperative atelectasis were found among patients with COU following posterior and circumferential lumbar fusions. The Elixhauser Mortality Index was also independently associated with atelectasis. Knowledge of these risks may allow for earlier identification and intervention in patients who are at risk.
全球范围内慢性阿片类药物使用（COU）持续上升，这是患者发病率的一个标志，也是不良健康结局的一个风险因素。阿片类药物的使用是呼吸抑制的一个风险因素，可能导致呼吸功能障碍，这是肺不张的已知原因。本研究的目的是确定 COU 是否与佛罗里达州、肯塔基州和纽约州在 2013-2015 年间接受前路、后路或环锯入路腰椎融合术的患者术后肺不张发生率增加有关。
使用三个州的住院患者数据库，确定在佛罗里达州、肯塔基州和纽约州接受前路、后路或环锯入路选择性腰椎融合术的患者。使用 ICD 诊断代码识别有 COU 和术后肺不张的患者。创建了三个手术组，并通过倾向评分进行了随后的匹配，以便为分析提供可比的队列。使用年龄、性别、种族、慢性诊断数量和入院地理州等变量进行了三对一的倾向评分匹配。多变量逻辑回归用于检查 COU 与术后肺不张之间的关系。
共确定了 3618 例腰椎融合术。NCOU 患者中有 1.33%发生肺不张，COU 患者中有 2.32%发生肺不张。在多变量分析中，在校正 Elixhauser 死亡率指数和患者保险状况后，COU 与后路腰椎融合术（OR=2.27；95%CI：1.09-4.72；p=0.028）和环锯腰椎融合术（OR=4.68；95%CI：1.52-14.45；p=0.007）显著相关。Elixhauser 死亡率指数也与后路腰椎融合术（OR=1.08；95%CI：1.04-1.11；p<0.001）和环锯腰椎融合术（OR=1.09；95%CI：1.03-1.16；p=0.002）的肺不张显著相关。
COU 患者后路和环锯腰椎融合术后发现更高的术后肺不张发生率。Elixhauser 死亡率指数也与肺不张独立相关。了解这些风险可能有助于对有风险的患者进行早期识别和干预。
