Farooqi Ali S, Detchou Donald K E, Glauser Gregory, Strouz Krista, McClintock Scott D, Malhotra Neil R
1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, and.
2McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia; and.
J Neurosurg Spine. 2021 Aug 6;35(5):571-582. doi: 10.3171/2020.12.SPINE201861. Print 2021 Nov 1.
There is a paucity of research on the safety of overlapping surgery. The purpose of this study was to evaluate the impact of overlapping surgery on a homogenous population of exactly matched patients undergoing single-level, posterior-only lumbar fusion.
The authors retrospectively analyzed case data of 3799 consecutive adult patients who underwent single-level, posterior-only lumbar fusion during a 6-year period (June 7, 2013, to April 29, 2019) at a multihospital university health system. Outcomes included 30-day emergency department (ED) visit, readmission, reoperation, and morbidity and mortality following surgery. Thereafter, coarsened exact matching was used to match patients with and without overlap on key demographic factors, including American Society of Anesthesiologists (ASA) class, Charlson Comorbidity Index (CCI) score, sex, and body mass index (BMI), among others. Patients were subsequently matched by both demographic data and by the specific surgeon performing the operation. Univariate analysis was carried out on the whole population, the demographically matched cohort, and the surgeon-matched cohort, with significance set at a p value < 0.05.
There was no significant difference in morbidity or any short-term outcome, including readmission, reoperation, ED evaluation, and mortality. Among the demographically matched cohort and surgeon-matched cohort, there was no significant difference in age, sex, history of prior surgery, ASA class, or CCI score. Overlapping surgery patients in both the demographically matched cohort and the matched cohort limited by surgeon had longer durations of surgery (p < 0.01), but no increased morbidity or mortality was noted. Patients selected for overlap had fewer prior surgeries and lower ASA class and CCI score (p < 0.01). Patients with overlap also had a longer duration of surgery (p < 0.01) but not duration of closure.
Exactly matched patients undergoing overlapping single-level lumbar fusion procedures had no increased short-term morbidity or mortality; however, duration of surgery was 20 minutes longer on average for overlapping operations. Further studies should assess long-term patient outcomes and the impact of overlap in this and other surgical procedures.
关于重叠手术安全性的研究较少。本研究的目的是评估重叠手术对接受单节段、仅后路腰椎融合术的完全匹配的同质患者群体的影响。
作者回顾性分析了在一所多医院大学卫生系统中，在6年期间（2013年6月7日至2019年4月29日）连续接受单节段、仅后路腰椎融合术的3799例成年患者的病例数据。结果包括术后30天的急诊科就诊、再入院、再次手术以及发病率和死亡率。此后，使用粗化精确匹配在关键人口统计学因素上对有重叠和无重叠的患者进行匹配，这些因素包括美国麻醉医师协会（ASA）分级、查尔森合并症指数（CCI）评分、性别和体重指数（BMI）等。随后，根据人口统计学数据和进行手术的具体外科医生对患者进行匹配。对总体人群、人口统计学匹配队列和外科医生匹配队列进行单因素分析，显著性设定为p值<0.05。
发病率或任何短期结果，包括再入院、再次手术、急诊科评估和死亡率，均无显著差异。在人口统计学匹配队列和外科医生匹配队列中，年龄、性别、既往手术史、ASA分级或CCI评分均无显著差异。人口统计学匹配队列和外科医生匹配队列中的重叠手术患者手术时间更长（p<0.01），但未观察到发病率或死亡率增加。选择进行重叠手术的患者既往手术较少，ASA分级和CCI评分较低（p<0.01）。有重叠的患者手术时间也更长（p<0.01），但关闭时间无差异。
接受重叠单节段腰椎融合手术的完全匹配患者短期发病率和死亡率没有增加；然而，重叠手术的平均手术时间长20分钟。进一步的研究应评估患者的长期结局以及重叠在此手术和其他手术中的影响。
