神经外科医师协会系统评价与循证指南：脊柱围手术期-术前手术风险评估

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Surgical Risk Assessment.

机构信息

Department of Neurological Surgery and Department of Orthopedic Surgery, Thomas Jefferson University, Division of Spine and Peripheral Nerve Surgery, Delaware Valley SCI Center, Philadelphia, Pennsylvania, USA.

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.

出版信息

Neurosurgery. 2021 Oct 13;89(Suppl 1):S9-S18. doi: 10.1093/neuros/nyab316.

DOI:10.1093/neuros/nyab316

PMID:34490886

Abstract

BACKGROUND

Patient factors (increased body mass index [BMI], smoking, and diabetes) may impact outcomes after spine surgery. There is a lack of consensus regarding which factors should be screened for and potentially modified preoperatively to optimize outcome.

OBJECTIVE

The purpose of this evidence-based clinical practice guideline is to determine if preoperative patient factors of diabetes, smoking, and increased BMI impact surgical outcomes.

METHODS

A systematic review of the literature for studies relevant to spine surgery was performed using the National Library of Medicine PubMed database and the Cochrane Library. Clinical studies evaluating the impact of diabetes or increased BMI with reoperation and/or surgical site infection (SSI) were selected for review. In addition, the impact of preoperative smoking on patients undergoing spinal fusion was reviewed.

RESULTS

A total of 699 articles met inclusion criteria and 64 were included in the systematic review. In patients with diabetes, a preoperative hemoglobin A1c (HbA1c) >7.5 mg/dL is associated with an increased risk of reoperation or infection after spine surgery. The review noted conflicting studies regarding the relationship between increased BMI and SSI or reoperation. Preoperative smoking is associated with increased risk of reoperation (Grade B). There is insufficient evidence that cessation of smoking before spine surgery decreases the risk of reoperation.

CONCLUSION

This evidence-based guideline provides a Grade B recommendation that diabetic individuals undergoing spine surgery should have a preoperative HbA1c test before surgery and should be counseled regarding the increased risk of reoperation or infection if the level is >7.5 mg/dL. There is conflicting evidence that BMI correlates with greater SSI rate or reoperation rate (Grade I). Smoking is associated with increased risk of reoperation (Grade B) in patients undergoing spinal fusion.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/2-preoperative-surgical-risk-assessement.

摘要

背景

患者因素（体重指数增加[BMI]、吸烟和糖尿病）可能会影响脊柱手术后的结果。目前，对于哪些因素应进行筛查以及术前可能需要进行哪些修改以优化结果，尚未达成共识。

目的

本循证临床实践指南旨在确定糖尿病、吸烟和 BMI 增加等术前患者因素是否会影响手术结果。

方法

使用美国国立医学图书馆 PubMed 数据库和 Cochrane 图书馆对与脊柱手术相关的文献进行系统回顾。选择评估糖尿病或 BMI 增加与再次手术和/或手术部位感染（SSI）关系的临床研究进行综述。此外，还回顾了术前吸烟对接受脊柱融合术患者的影响。

结果

共有 699 篇文章符合纳入标准，其中 64 篇文章被纳入系统综述。对于糖尿病患者，术前糖化血红蛋白（HbA1c）>7.5mg/dL 与脊柱手术后再次手术或感染的风险增加相关。该综述指出，关于 BMI 与 SSI 或再次手术之间的关系存在相互矛盾的研究。术前吸烟与再次手术风险增加相关（B 级）。目前尚无足够证据表明脊柱手术前戒烟可降低再次手术的风险。

结论

本循证指南建议 B 级，即接受脊柱手术的糖尿病患者应在手术前进行 HbA1c 检测，如果水平>7.5mg/dL，应告知其再次手术或感染的风险增加。BMI 与 SSI 发生率或再次手术率增加相关的证据相互矛盾（I 级）。吸烟与接受脊柱融合术患者的再次手术风险增加相关（B 级）。完整的指南可在 https://www.cns.org/guidelines/browse-guidelines-detail/2-preoperative-surgical-risk-assessement 上获取。