Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
World Neurosurg. 2021 May;149:e729-e736. doi: 10.1016/j.wneu.2021.01.110. Epub 2021 Feb 3.
Rheumatoid arthritis (RA) is a systemic disease with prominent musculoskeletal manifestations that is associated with increased morbidity and mortality in patients undergoing cervical spine surgery; however, few studies have specifically examined postoperative outcomes in patients with RA following lumbar surgery. The aim of this study was to evaluate whether patients with RA who underwent posterior lumbar fusion experienced increased postoperative complications and economic burden compared with patients without RA.
Patients <85 years old who underwent elective 1- or 2-level instrumented posterior lumbar fusion for degenerative lumbar pathology between 2006 and 2012 were identified in the Medicare insurance claims database. Same-day revisions and cases for spinal infection, malignancy, and trauma were excluded. The resulting cohort was divided into patients with RA before fusion and patients without RA (controls). All outcomes of interest were compared using multivariate regression. Reoperation-free survival at 1- and 2-year follow-up was analyzed used log-rank test. Significance was defined as P < 0.05.
RA patients had significantly higher risk of 90-day readmission (odds ratio [OR] = 1.27, P < 0.001), thromboembolic events (OR = 1.39, P = 0.010), sepsis (OR = 2.32, P < 0.001), pneumonia (OR = 1.57, P = 0.001), and wound complications (OR = 1.41, P < 0.001). Reoperation-free survival was significantly lower in RA patients at 2-year follow-up (90.4% vs. 92.4%, P < 0.001). Following adjusted regression, RA independently contributed to a $1491 increase in additional 90-day costs (P < 0.001).
Preexisting RA may increase risk for short-term postoperative medical complications following posterior lumbar fusion, specifically infectious events. In addition, patients with RA have higher rates of subsequent reoperation following index surgery. Patients with RA be should counseled regarding these risks.
类风湿关节炎（RA）是一种以突出的肌肉骨骼表现为特征的系统性疾病，与接受颈椎手术的患者的发病率和死亡率增加有关；然而，很少有研究专门检查腰椎手术后 RA 患者的术后结果。本研究旨在评估接受后路腰椎融合术的 RA 患者与无 RA 患者相比，是否术后并发症和经济负担增加。
从医疗保险索赔数据库中确定了 2006 年至 2012 年间因退行性腰椎病变接受 1 或 2 级后路器械固定腰椎融合术的年龄<85 岁的患者。排除了当天的翻修和脊柱感染、恶性肿瘤和创伤的病例。将得到的队列分为融合前有 RA 的患者和无 RA 的患者（对照组）。使用多元回归比较所有感兴趣的结果。使用对数秩检验分析 1 年和 2 年随访的无再手术生存率。定义显著性水平为 P < 0.05。
RA 患者 90 天再入院的风险显著升高（优势比 [OR] = 1.27，P < 0.001），血栓栓塞事件（OR = 1.39，P = 0.010），脓毒症（OR = 2.32，P < 0.001），肺炎（OR = 1.57，P = 0.001），和伤口并发症（OR = 1.41，P < 0.001）。RA 患者在 2 年随访时无再手术生存率显著降低（90.4% vs. 92.4%，P < 0.001）。经调整后的回归分析，RA 独立导致 90 天额外费用增加 1491 美元（P < 0.001）。
后路腰椎融合术后，预先存在的 RA 可能会增加短期术后医疗并发症的风险，特别是感染性事件。此外，RA 患者在指数手术后再次手术的发生率更高。应向 RA 患者提供这些风险的咨询。
