Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Neurosurgery. 2021 Nov 18;89(6):1052-1061. doi: 10.1093/neuros/nyab360.
Few studies have assessed the impact of overlapping surgery during different timepoints of neurosurgical procedures.
To evaluate the impact of overlap before the critical portion of surgery on short-term patient outcomes following lumbar fusion.
In total, 3799 consecutive patients who underwent single-level, posterior-only lumbar fusion over 6 yr (2013-2019) at an academic hospital system were retrospectively studied. Outcomes included 30-d emergency department (ED) visit, readmission, reoperation, mortality, overall morbidity, and overall morbidity/surgical complications. Duration of overlap that occurred before the critical portion of surgery was calculated as a percentage of total beginning operative time. Univariate logistic regression was used to assess the impact of incremental 1% increases in the duration of overlap within the whole population and patients with beginning overlap. Subsequently, univariate analysis was used to compare exact matched patients with the least (bottom 40%) and most amounts of overlap (100% beginning overlap). Coarsened exact matching was used to match patients on key demographic factors, as well as attending surgeon. Significance was set at a P-value < .05.
Increased duration of beginning overlap was associated with a decrease in 30-d ED visit (P = .03) within all patients with beginning overlap, but not within the whole population undergoing lumbar fusion. Duration of beginning overlap was not associated with any other short-term morbidity or mortality outcome in either the whole population or patients with beginning overlap.
Increased duration of overlap before the critical step of surgery does not predict adverse short-term outcomes after single-level, posterior-only lumbar fusion.
很少有研究评估在神经外科手术的不同时间点进行重叠手术的影响。
评估在手术关键部分之前重叠对腰椎融合术后短期患者结局的影响。
在一个学术医院系统中，回顾性研究了在 6 年（2013-2019 年）期间接受单节段后路腰椎融合术的 3799 例连续患者。结果包括术后 30d 内急诊就诊、再入院、再次手术、死亡率、总发病率和总发病率/手术并发症。重叠发生在手术关键部分之前的时间长度计算为总手术开始时间的百分比。使用单变量逻辑回归评估重叠持续时间在整个人群和有开始重叠的患者中每增加 1%对结局的影响。随后，使用单变量分析比较重叠量最少（最低 40%）和最多（100%开始重叠）的精确匹配患者。使用粗化精确匹配根据关键人口统计学因素以及主治医生匹配患者。显著性水平设为 P 值<.05。
在所有有开始重叠的患者中，开始重叠的持续时间增加与术后 30d 内急诊就诊减少相关（P=.03），但在整个行腰椎融合术的人群中则不然。开始重叠的持续时间与整个人群或有开始重叠的患者的任何其他短期发病率或死亡率结果均无关联。
在手术关键步骤之前重叠时间的增加并不能预测单节段后路腰椎融合术后的短期不良结局。
