脑瘫儿童脊柱融合术后胃肠道并发症的危险因素。
Risk factors for gastrointestinal complications after spinal fusion in children with cerebral palsy.
机构信息
Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Orthopaedic Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA.
出版信息
Spine Deform. 2021 Mar;9(2):567-578. doi: 10.1007/s43390-020-00233-y. Epub 2020 Nov 17.
DESIGN
Prospective cerebral palsy (CP) registry review.
OBJECTIVES
(1) Evaluate the incidence/risk factors of gastrointestinal (GI) complications in CP patients after spinal fusion (SF); and (2) investigate the validity of the modified Clavien-Dindo-Sink classification.
BACKGROUND
Perioperative GI complications result in increased length of stay (LOS) and patient morbidity/mortality. However, none have analyzed the outcomes of GI complications using an objective classification system.
METHODS
A prospective/multicenter CP database identified 425 children (mean, 14.4 ± 2.9 years; range, 7.9-21 years) who underwent SF. GI complications were categorized using the modified Clavien-Dindo-Sink classification. Grades I-II were minor complications and grades III-V major. Patients with and without GI complications were compared.
RESULTS
87 GI complications developed in 69 patients (16.2%): 39 minor (57%) and 30 major (43%). Most common were pancreatitis (n = 45) and ileus (n = 22). Patients with preoperative G-tubes had 2.2 × odds of developing a GI complication compared to oral-only feeders (OR 2.2; 95% CI 0.98-4.78; p = 0.006). Similarly, combined G-tube/oral feeders had 6.7 × odds compared to oral-only (OR 6.7; 95% CI 3.10-14.66; p < 0.001). The likelihood of developing a GI complication was 3.4 × with normalized estimated blood loss (nEBL) ≥ 3 ml/kg/level fused (OR 3.41; 95% CI 1.95-5.95; p < 0.001). Patients with GI complications had more fundoplications (29% vs. 17%; p = 0.03) and longer G-tube fasting periods (3 days vs. 2 days; p < 0.001), oral fasting periods (5 days vs. 2 days; p < 0.001), ICU admissions (6 days vs. 3 days; p = 0.002), and LOS (15 days vs. 8 days; p < 0.001). LOS correlated with the Clavien-Dino-Sink classification.
CONCLUSION
Gastrointestinal complications such as pancreatitis and ileus are not uncommon after SF in children with CP. This is the first study to investigate the validity of the modified Clavien-Dindo-Sink classification in GI complications after SF. Our results suggest a correlation between complication severity grade and LOS. The complexity of perioperative enteral nutritional supplementation requires prospective studies dedicated to enteral feeding protocols.
LEVEL OF EVIDENCE
Therapeutic-level III.
设计
前瞻性脑瘫（CP）登记研究。
目的
（1）评估脊柱融合（SF）后 CP 患者胃肠道（GI）并发症的发生率/危险因素；（2）探讨改良 Clavien-Dindo-Sink 分级的有效性。
背景
围手术期 GI 并发症会导致住院时间延长（LOS）和患者发病率/死亡率增加。然而，目前还没有使用客观分类系统分析 GI 并发症的结果。
方法
前瞻性/多中心 CP 数据库纳入了 425 名儿童（平均年龄 14.4±2.9 岁；范围 7.9-21 岁），他们接受了 SF。GI 并发症使用改良的 Clavien-Dindo-Sink 分级进行分类。I-II 级为轻度并发症，III-V 级为重度并发症。比较有和无 GI 并发症的患者。
结果
69 名患者（16.2%）发生 87 例 GI 并发症：39 例轻度（57%）和 30 例重度（43%）。最常见的是胰腺炎（n=45）和肠梗阻（n=22）。术前使用胃管的患者发生 GI 并发症的几率是仅经口喂养患者的 2.2 倍（OR 2.2；95%CI 0.98-4.78；p=0.006）。同样，联合使用胃管/口服喂养的患者发生 GI 并发症的几率是仅经口喂养患者的 6.7 倍（OR 6.7；95%CI 3.10-14.66；p<0.001）。校正估计失血量（nEBL）≥3ml/kg/融合水平后（OR 3.41；95%CI 1.95-5.95；p<0.001），发生 GI 并发症的几率增加 3.4 倍。发生 GI 并发症的患者有更多的胃底折叠术（29%比 17%；p=0.03）和更长的胃管禁食时间（3 天比 2 天；p<0.001）、更长的口服禁食时间（5 天比 2 天；p<0.001）、更长的 ICU 入住时间（6 天比 3 天；p=0.002）和更长的 LOS（15 天比 8 天；p<0.001）。LOS 与 Clavien-Dino-Sink 分级相关。
结论
CP 儿童 SF 后，胰腺炎和肠梗阻等胃肠道并发症并不少见。这是第一项研究改良的 Clavien-Dindo-Sink 分级在 SF 后 GI 并发症中的有效性。我们的结果表明，并发症严重程度与 LOS 之间存在相关性。围手术期肠内营养补充的复杂性需要前瞻性研究专门针对肠内喂养方案。
证据水平
治疗性 III 级。
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