Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2021 May;149:e737-e747. doi: 10.1016/j.wneu.2021.01.109. Epub 2021 Feb 3.
The aim of this study was to determine the impact of preoperative pulmonary risk factors (PRFS) on surgical outcomes after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).
A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database from 2016 to 2018. All pediatric patients with AIS undergoing PSF were identified. Patients were then categorized by whether they had recorded baseline PRF or no-PRF. Patient demographics, comorbidities, intraoperative variables, complications, length of stay, discharge disposition, and readmission rate were assessed.
A total of 4929 patients were identified, of whom 280 (5.7%) had baseline PRF. Compared with the no-PRF cohort, the PRF cohort had higher rates of complications (PRF, 4.3% vs. no-PRF, 2.2%; P = 0.03) and longer hospital stays (PRF, 4.6 ± 4.3 days vs. no-PRF, 3.8 ± 2.3 days; P < 0.001), yet, discharge disposition was similar between cohorts (P = 0.70). Rates of 30-day unplanned readmission were significantly higher in the PRF cohort (PRF, 6.3% vs. no-PRF, 2.7%; P = 0.009), yet, days to readmission (P = 0.76) and rates of 30-day reoperation (P = 0.16) were similar between cohorts. On multivariate analysis, PRF was found to be a significant independent risk factor for longer hospital stays (risk ratio, 0.74; 95% confidence interval, 0.44-1.04; P < 0.001) but not postoperative complication or 30-day unplanned readmission.
Our study showed that PRF may be a risk factor for slightly longer hospital stays without higher rates of complication or unplanned readmission for patients with AIS undergoing PSF and thus should not preclude surgical management.
本研究旨在确定术前肺部风险因素（PRFS）对青少年特发性脊柱侧凸（AIS）后路脊柱融合术（PSF）后手术结果的影响。
使用美国外科医师学会国家外科质量改进计划-儿科数据库，回顾性分析了 2016 年至 2018 年接受 PSF 的所有 AIS 患儿的病例资料。根据是否存在基线 PRF 将患者分为 PRF 组和非 PRF 组。评估患者的人口统计学特征、合并症、术中变量、并发症、住院时间、出院去向和再入院率。
共纳入 4929 例患者，其中 280 例（5.7%）存在基线 PRF。与非 PRF 组相比，PRF 组的并发症发生率更高（PRF 组为 4.3%，非 PRF 组为 2.2%；P=0.03），住院时间更长（PRF 组为 4.6±4.3 天，非 PRF 组为 3.8±2.3 天；P<0.001），但两组的出院去向相似（P=0.70）。PRF 组 30 天内非计划再入院率显著更高（PRF 组为 6.3%，非 PRF 组为 2.7%；P=0.009），但再入院时间（P=0.76）和 30 天内再次手术率（P=0.16）在两组间相似。多变量分析显示，PRF 是住院时间延长的独立危险因素（风险比，0.74；95%置信区间，0.44-1.04；P<0.001），但不是术后并发症或 30 天内非计划再入院的危险因素。
本研究表明，PRF 可能是 AIS 患者 PSF 后住院时间延长的危险因素，但并发症或 30 天内非计划再入院率并无升高，因此不应排除手术治疗。
