Staartjes Victor E, Joswig Holger, Corniola Marco V, Schaller Karl, Gautschi Oliver P, Stienen Martin N
Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Neurosurgery, Health and Medical University Potsdam, Ernst von Bergmann Hospital, Potsdam, Germany.
Global Spine J. 2022 Jul;12(6):1184-1191. doi: 10.1177/2192568220979120. Epub 2020 Dec 17.
Analysis of a prospective 2-center database.
Medical comorbidities co-determine clinical outcome. Objective functional impairment (OFI) provides a supplementary dimension of patient assessment. We set out to study whether comorbidities are associated with the presence and degree of OFI in this patient population.
Patients with degenerative diseases of the spine preoperatively performed the timed-up-and-go (TUG) test and a battery of questionnaires. Comorbidities were quantified using the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiology (ASA) grading. Crude and adjusted linear regression models were fitted.
Of 375 included patients, 97 (25.9%) presented at least some degree of medical comorbidity according to the CCI, and 312 (83.2%) according to ASA grading. In the univariate analysis, the CCI was inconsistently associated with OFI. Only patients with low-grade CCI comorbidity displayed significantly higher TUG test times (p = 0.004). In the multivariable analysis, this effect persisted for patients with CCI = 1 (p = 0.030). Regarding ASA grade, patients with ASA = 3 exhibited significantly increased TUG test times (p = 0.003) and t-scores (p = 0.015). This effect disappeared after multivariable adjustment (p = 0.786 and p = 0.969). In addition, subjective functional impairment according to ODI, and EQ5D index was moderately associated with comorbidities according to ASA (all p < 0.05).
The degree of medical comorbidities appears only weakly and inconsistently associated with OFI in patients scheduled for degenerative lumbar spine surgery, especially after controlling for potential confounders. TUG testing may be valid even in patients with relatively severe comorbidities who are able to complete the test.
对一个前瞻性双中心数据库进行分析。
医学合并症共同决定临床结局。客观功能损害（OFI）为患者评估提供了一个补充维度。我们着手研究在该患者群体中合并症是否与OFI的存在及程度相关。
患有脊柱退行性疾病的患者术前进行定时起立行走（TUG）测试和一系列问卷调查。使用Charlson合并症指数（CCI）和美国麻醉医师协会（ASA）分级对合并症进行量化。拟合了粗线性回归模型和调整线性回归模型。
在纳入的375例患者中，根据CCI，97例（25.9%）至少存在某种程度的医学合并症，根据ASA分级则为312例（83.2%）。在单变量分析中，CCI与OFI的相关性不一致。只有CCI合并症程度较低的患者TUG测试时间显著更长（p = 0.004）。在多变量分析中，对于CCI = 1的患者，这种效应仍然存在（p = 0.030）。关于ASA分级，ASA = 3的患者TUG测试时间显著增加（p = 0.003），t评分也显著增加（p = 0.015）。多变量调整后这种效应消失（p = 0.786和p = 0.969）。此外，根据ODI和EQ5D指数的主观功能损害与根据ASA分级的合并症中度相关（所有p < 0.05）。
对于计划进行退行性腰椎手术的患者，医学合并症的程度与OFI的关联似乎较弱且不一致，尤其是在控制潜在混杂因素之后。即使是能够完成测试的合并症相对严重的患者，TUG测试可能也是有效的。
