Passias Peter G, Naessig Sara, Para Ashok, Ahmad Waleed, Pierce Katherine, Janjua M Burhan, Vira Shaleen, Sciubba Daniel, Diebo Bassel
Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA.
Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA.
J Craniovertebr Junction Spine. 2020 Jul-Sep;11(3):169-172. doi: 10.4103/jcvjs.JCVJS_69_20. Epub 2020 Aug 14.
This study aimed to identify complication trends of Chiari Malformation Type 1 patients (CM-1) for certain procedures and concomitant diagnoses on a national level.
The Kids' Inpatient Database was queried for diagnoses of operative CM-1 by International Classification of Disease-9 codes (348.4). Differences in preoperative demographics and perioperative complication rates between patient cohorts were assessed using Pearson's Chi-squared test and -test when necessary. Binary logistic regression was utilized to find significant factors associated with complication rate. Certain surgical procedures were analyzed for their relationship with postoperative outcomes.
Thirteen thousand eight hundred and twelve CM-1 patients were identified with 8.2% suffering from a complication. From 2003 to 2012, the rate of complications for CM-1 pts decreased significantly (9.6%-5.1%) along with surgical rate (33.3%-28.6%), despite the increase in CM-1 diagnosis (36.3%-42.3%; all < 0.05). CM-1 pts who had a complication were younger and had a lower invasiveness score; however, they had a larger Charlson Comorbidity Index than those who did not have a complication (all < 0.05). CM-1 pts who experienced complications had a concurrent diagnosis of syringomyelia (7.1%), and also scoliosis (3.2%; all < 0.05). CM-1 pts who did not have a complication had a greater rate of operation than those that had a complication (76.4% vs. 23.6% < 0.05). The most common complications were nervous system related (2.8%), anemia (2.4%), and acute respiratory distress (2.1%). CM-1 pts that underwent an instrumented fusion (3.4% vs. 2.1%) had a greater complication rate as well as compared to those who underwent a craniotomy (23.2% vs. 19.1%; all < 0.05). However, CM-1 pts that underwent a decompression had lower postoperative complications (21.3% vs. 28.9%; all < 0.05).
Chiari patients undergoing craniectomies as well as instrumented fusions are at a higher risk of postoperative complications especially when the instrumented fusions were performed on >4 levels.
本研究旨在确定全国范围内1型Chiari畸形患者（CM - 1）在特定手术及伴随诊断方面的并发症趋势。
通过国际疾病分类第9版编码（348.4）在儿童住院数据库中查询手术性CM - 1的诊断情况。必要时，使用Pearson卡方检验和t检验评估患者队列术前人口统计学和围手术期并发症发生率的差异。采用二元逻辑回归分析与并发症发生率相关的显著因素。分析某些外科手术与术后结果的关系。
共识别出13812例CM - 1患者，其中8.2%发生了并发症。从2003年到2012年，CM - 1患者的并发症发生率（9.6% - 5.1%）和手术率（33.3% - 28.6%）均显著下降，尽管CM - 1诊断有所增加（36.3% - 42.3%；均P < 0.05）。发生并发症的CM - 1患者年龄更小，侵袭性评分更低；然而，他们的Charlson合并症指数高于未发生并发症的患者（均P < 0.05）。发生并发症的CM - 1患者同时合并脊髓空洞症的比例为7.1%，合并脊柱侧弯的比例为3.2%（均P < 0.05）。未发生并发症的CM - 1患者的手术率高于发生并发症的患者（76.4%对23.6%，P < 0.05）。最常见的并发症与神经系统相关（2.8%）、贫血（2.4%）和急性呼吸窘迫（2.1%）。接受器械融合手术的CM - 1患者（3.4%对2.1%）以及与接受开颅手术的患者相比（23.2%对19.1%）并发症发生率更高（均P < 0.05）。然而，接受减压手术的CM - 1患者术后并发症较少（21.3%对28.9%；均P < 0.05）。
接受颅骨切除术以及器械融合手术的Chiari患者术后并发症风险更高，尤其是当器械融合手术在4个以上节段进行时。
