Farooqi Ali S, Borja Austin J, Detchou Donald K E, Glauser Gregory, Strouz Krista, McClintock Scott D, Malhotra Neil R
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, USA; West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA, USA.
Clin Neurol Neurosurg. 2021 Jun;205:106610. doi: 10.1016/j.clineuro.2021.106610. Epub 2021 Mar 25.
The relationship between degree of surgical overlap and adverse postoperative outcomes remains poorly defined. This study aims to evaluate the impact of increasing duration of overlap on lumbar fusion outcomes.
1302 adult patients undergoing overlapping surgery during single-level, posterior-only lumbar fusion at a multi-hospital, university health system were retrospectively assessed. Amount of overlap was calculated as a percentage of total overlap time. Patients were separated into groups with the most (top 10% of patients) and least amounts of overlap (bottom 40% of patients). Using Coarsened Exact Matching, patients with the most and least amounts of overlap were matched on demographics alone, then on both demographics and attending surgeon. Univariate analysis was performed for the whole population and both matched cohorts to compare amount of overlap to risk of adverse postsurgical events. Significance for all analyses was p-value < 0.05.
Duration of overlap was not associated with outcomes in the whole population, demographic-matched, or surgeon-matched analyses. Before exact matching, patients with the most amount of overlap had a significantly higher CCI score (p = 0.031) and shorter length of surgery (p = 0.006). In the demographic matched cohort, patients with increased overlap had a significantly shorter length of surgery (p = 0.001) only. In the surgeon matched cohort, there were no differences in length of surgery or CCI score.
Duration of surgical overlap does not predict adverse outcomes following lumbar fusion. These results suggest that overlapping surgery is a safe practice within this common neurosurgical indication.
手术重叠程度与术后不良结局之间的关系仍未明确界定。本研究旨在评估重叠时间增加对腰椎融合术结局的影响。
对在一家多医院的大学卫生系统接受单节段、仅后路腰椎融合术中重叠手术的1302例成年患者进行回顾性评估。重叠量计算为总重叠时间的百分比。患者被分为重叠量最大（患者前10%）和最小（患者后40%）的组。使用粗化精确匹配，仅根据人口统计学对重叠量最大和最小的患者进行匹配，然后根据人口统计学和主刀医生进行匹配。对整个人群以及两个匹配队列进行单因素分析，以比较重叠量与术后不良事件风险。所有分析的显著性为p值<0.05。
在整个人群、人口统计学匹配或医生匹配分析中，重叠持续时间与结局均无关联。在精确匹配之前，重叠量最大的患者CCI评分显著更高（p = 0.031），手术时间更短（p = 0.006）。在人口统计学匹配队列中，重叠增加的患者仅手术时间显著更短（p = 0.001）。在医生匹配队列中，手术时间或CCI评分无差异。
手术重叠持续时间不能预测腰椎融合术后的不良结局。这些结果表明，在这种常见的神经外科适应症范围内，重叠手术是一种安全的做法。
