Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Korean Med Sci. 2020 Oct 19;35(40):e345. doi: 10.3346/jkms.2020.35.e345.
Spinal surgery holds a higher chance of unpredicted postoperative medical complications among orthopedic surgeries. Several studies have analyzed the risk factors for diverse postoperative medical complications, but the majority investigated incidences of each complication qualitatively. Among gastrointestinal complications, reports regarding postoperative ileus were relatively frequent. However, risk factors or incidences of hepatobiliary complications have yet to be investigated. The purpose of this study was to examine the incidence of gastrointestinal complications after spinal surgery, quantitatively analyze the risk factors of frequent complications, and to determine cues requiring early approaches.
In total, 234 consecutive patients who underwent spinal fusion surgery performed by one senior doctor at our institute in one-year period were retrospectively enrolled for analyses. The primary outcomes were presence of paralytic ileus, elevated serum alanine transaminase (ALT) and aspartate transaminase (AST) levels, and elevated total bilirubin levels. Univariate logistic regression analyses of all variables were performed. In turn, significant results were reanalyzed by multivariate logistic regression. The variables used were adjusted with age and gender.
Gastrointestinal complications were observed in 15.8% of patients. Upon the risk factors of postoperative ileus, duration of anesthesia (odds ratio [OR], 1.373; = 0.015), number of fused segments (OR, 1.202; = 0.047), and hepatobiliary diseases (OR, 2.976; = 0.029) were significantly different. For elevated liver enzymes, men (OR, 2.717; = 0.003), number of fused segments (OR, 1.234; = 0.033), and underlying hepatobiliary (OR, 2.704; = 0.031) and rheumatoid diseases (OR, 5.021; = 0.012) had significantly different results. Lastly, risk factors for total bilirubin elevation were: duration of anesthesia (OR, 1.431; = 0.008), number of fused segments (OR, 1.359; = 0.001), underlying hepatobiliary diseases (OR, 3.426; = 0.014), and thoracolumbar junction involving fusions (OR, 4.134; = 0.002) compared to lumbar spine limited fusions.
Patients on postoperative care after spinal surgery should receive direct attention as soon as possible after manifesting abdominal symptoms. Laboratory and radiologic results must be carefully reviewed, and early consultation to gastroenterologists or general surgeons is recommended to avoid preventable complications.
脊柱手术在骨科手术中发生术后意外医疗并发症的几率更高。有几项研究分析了各种术后医疗并发症的危险因素，但大多数研究都是定性地调查每种并发症的发生率。在胃肠道并发症中，术后肠梗阻的报告相对频繁。然而，尚未研究肝胆并发症的危险因素或发生率。本研究旨在定量分析胃肠道并发症的发生率，分析常见并发症的危险因素，并确定需要早期处理的线索。
回顾性分析了我院一名资深医生在一年时间内进行的 234 例脊柱融合手术患者的资料。主要结果是存在麻痹性肠梗阻、血清丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）水平升高以及总胆红素水平升高。对所有变量进行单变量逻辑回归分析。然后，对有意义的结果进行多变量逻辑回归分析。使用的变量经过年龄和性别调整。
15.8%的患者出现胃肠道并发症。术后肠梗阻的危险因素有麻醉持续时间（比值比[OR]，1.373；P=0.015）、融合节段数（OR，1.202；P=0.047）和肝胆疾病（OR，2.976；P=0.029）。对于肝功能酶升高，男性（OR，2.717；P=0.003）、融合节段数（OR，1.234；P=0.033）、肝胆疾病（OR，2.704；P=0.031）和类风湿性疾病（OR，5.021；P=0.012）存在显著差异。最后，总胆红素升高的危险因素为：麻醉持续时间（OR，1.431；P=0.008）、融合节段数（OR，1.359；P=0.001）、肝胆疾病（OR，3.426；P=0.014）和胸腰椎交界处融合（OR，4.134；P=0.002），与仅累及腰椎的融合相比。
脊柱手术后的患者在出现腹部症状后应立即接受密切关注。必须仔细审查实验室和影像学结果，并建议尽早咨询胃肠病专家或普外科医生，以避免可预防的并发症。
