Shahrestani Shane, Ballatori Alexander M, Chen Xiao T, Ton Andy, Buser Zorica, Wang Jeffrey C
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA.
Eur Spine J. 2022 Mar;31(3):669-677. doi: 10.1007/s00586-021-06857-6. Epub 2021 May 4.
Anterior thoracolumbar (TL) surgical approaches provide more direct trajectories compared to posterior approaches. Proper patient selection is key in identifying populations that may benefit from anterior TL fusion. Here, we utilize predictive analytics to identify risk factors in anterior TL fusion in patients with trauma and deformity.
In this retrospective cohort study of patients receiving anterior TL fusion (between and including T12/L1), population-based regression models were developed to identify risk factors using the National Readmission Database 2016-2017. Readmissions were analyzed at 30- and 90-day intervals. Risk factors included hypertension, obesity, malnutrition, smoking, alcohol use, long-term opioid use, and frailty. Multivariate regression models were developed to determine the influence of each risk factor on complication rates.
A total of 265 and 375 patients were identified for the scoliosis and burst fracture cohorts, respectively. In patients with scoliosis, alcohol use was found to increase the length of stay (LOS) (p = 0.00061) and all-payer inpatient cost following surgery (p = 0.014), and frailty was found to increase the inpatient LOS (p = 0.0045). In patients with burst fractures, malnutrition was found to increase the LOS (p < 0.0001) and all-payer cost (p < 0.0001), obesity was found to increase the all-payer cost (p = 0.012), and frailty was found to increase the all-payer cost (p = 0.031) and LOS (p < 0.0001).
Patient-specific risk factors in anterior TL fusion surgery significantly influence complication rates. An understanding of relevant risk factors before surgery may facilitate preoperative patient selection and postoperative patient triage and risk categorization.
与后路手术相比，胸腰段前路手术提供了更直接的手术路径。正确选择患者是确定可能从前路胸腰段融合手术中获益人群的关键。在此，我们利用预测分析来确定创伤和畸形患者前路胸腰段融合手术的风险因素。
在这项对接受前路胸腰段融合手术（T12/L1及以上）患者的回顾性队列研究中，利用2016 - 2017年国家再入院数据库建立基于人群的回归模型以确定风险因素。在30天和90天间隔时分析再入院情况。风险因素包括高血压、肥胖、营养不良、吸烟、饮酒、长期使用阿片类药物和身体虚弱。建立多变量回归模型以确定每个风险因素对并发症发生率的影响。
分别为脊柱侧弯和爆裂骨折队列确定了265例和375例患者。在脊柱侧弯患者中，发现饮酒会增加住院时间（LOS）（p = 0.00061）和术后所有支付方的住院费用（p = 0.014），且身体虚弱会增加住院时间（p = 0.0045）。在爆裂骨折患者中，发现营养不良会增加住院时间（p < 0.0001）和所有支付方费用（p < 0.0001），肥胖会增加所有支付方费用（p = 0.012），身体虚弱会增加所有支付方费用（p = 0.031）和住院时间（p < 0.0001）。
前路胸腰段融合手术中特定于患者的风险因素显著影响并发症发生率。术前了解相关风险因素可能有助于术前患者选择以及术后患者分类和风险分级。
