Department of Orthopedic Surgery, University of Massachusetts Memorial Medical Center, Worcester MA.
Department of Neurological Surgery, University of Massachusetts Memorial Medical Center, Worcester MA.
Spine (Phila Pa 1976). 2021 Jun 15;46(12):E655-E662. doi: 10.1097/BRS.0000000000003893.
Clinical case series.
The aim of this study was to determine the effectiveness of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator in the prediction of complications after anterior lumbar interbody fusion (ALIF).
Identifying at-risk patients may aid in the prevention of complications after spine procedures. The ACS NSQIP surgical risk calculator was developed to predict 30-day postoperative complications for a variety of operative procedures.
Medical records of patients undergoing ALIF at our institution from 2009 to 2019 were retrospectively reviewed. Demographic and comorbidity variables were entered into the ACS NSQIP surgical risk calculator to generate percentage predictions for complication incidence within 30 days postoperatively. The observed incidences of these complications were also abstracted from the medical record. The predictive ability of the ACS NSQIP surgical risk calculator was assessed in comparison to the observed incidence of complications using area under the curve (AUC) analyses.
Two hundred fifty-three (253) patients were analyzed. The ACS NSQIP surgical risk calculator was a fair predictor of discharge to non-home facility (AUC 0.71) and surgical site infection (AUC 0.70). The ACS NSQIP surgical risk calculator was a good predictor of acute kidney injury/progressive renal insufficiency (AUC 0.81). The ACS NSQIP surgical risk calculator was not an adequate predictive tool for any other category, including: pneumonia, urinary tract infections, venous thromboembolism, readmission, reoperations, and aggregate complications (AUC < 0.70).
The ACS NSQIP surgical risk calculator is an adequate predictive tool for a subset of complications after ALIF including acute kidney injury/progressive renal insufficiency, surgical site infections, and discharge to non-home facilities. However, it is a poor predictor for all other complication groups. The reliability of the ACS NSQIP surgical risk calculator is limited, and further identification of models for risk stratification is necessary for patients undergoing ALIF.Level of Evidence: 3.
临床病例系列。
本研究旨在确定美国外科医师学会全国手术质量改进计划（ACS NSQIP）手术风险计算器在预测前路腰椎间融合术（ALIF）后并发症方面的有效性。
确定高危患者可能有助于预防脊柱手术后的并发症。ACS NSQIP 手术风险计算器旨在预测各种手术 30 天后的术后并发症。
回顾性分析我院 2009 年至 2019 年接受 ALIF 的患者的病历。将人口统计学和合并症变量输入 ACS NSQIP 手术风险计算器，以生成术后 30 天内并发症发生率的百分比预测值。还从病历中提取这些并发症的实际发生率。使用曲线下面积（AUC）分析评估 ACS NSQIP 手术风险计算器的预测能力与并发症实际发生率的比较。
共分析了 253 例患者。ACS NSQIP 手术风险计算器对于非家庭设施出院（AUC 0.71）和手术部位感染（AUC 0.70）是一个公平的预测指标。ACS NSQIP 手术风险计算器对于急性肾损伤/进行性肾功能不全（AUC 0.81）是一个很好的预测指标。ACS NSQIP 手术风险计算器对于其他任何类别都不是一个足够的预测工具，包括：肺炎、尿路感染、静脉血栓栓塞、再入院、再次手术和总并发症（AUC<0.70）。
ACS NSQIP 手术风险计算器是 ALIF 后部分并发症的一个合适的预测工具，包括急性肾损伤/进行性肾功能不全、手术部位感染和非家庭设施出院。然而，它是所有其他并发症组的一个很差的预测指标。ACS NSQIP 手术风险计算器的可靠性有限，需要进一步确定用于接受 ALIF 的患者的风险分层模型。
3 级。
