Wang Kevin Y, Suresh Krishna V, Mo Kevin, Harris Andrew B, Marrache Majd, Kebaish Khaled M
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
World Neurosurg. 2022 May;161:e18-e24. doi: 10.1016/j.wneu.2021.10.125. Epub 2021 Oct 21.
To determine the association of preoperative hyponatremia with short-term postoperative complications and health care utilization (length of stay, readmissions) after anterior cervical fusion and discectomy (ACDF).
Patients who underwent ACDF were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients who had revision surgery, trauma, vertebral malignancy, or infection were excluded. Eunatremia was defined as sodium (Na) level between 135 and 145 mEq/L, whereas hyponatremia was defined as Na < 135 mEq/L. Preoperatively, patients with hyponatremia were matched 1:1 with patients with eunatremia using propensity score matching based on age, sex, American Society of Anesthesiologists score, and baseline comorbidities. Minor adverse events included superficial infection, dehiscence, urinary tract infection, pneumonia, and renal insufficiency or failure. Serious adverse events included deep wound infection, reintubation, pulmonary embolism, cerebrovascular accident, cardiac arrest, deep vein thrombosis, sepsis, return to operating room, and death within 30 days. Complications were analyzed using bivariate and logistic analysis with significance set at P < 0.05.
Of the 9094 patients undergoing ACDF, 3.64% (n = 331) were preoperatively hyponatremic. Preoperative hyponatremia was an independent risk factor for postoperative pneumonia after ACDF (odds ratio [OR], 4.47; P = 0.020) and extended length of hospital stay >1 SD above the mean (OR, 1.71; P = 0.042). Preoperative hyponatremia was an independent risk factor for having a serious adverse event (OR, 2.40; P = 0.005) and any adverse event (OR, 2.44; P = 0.009).
Preoperative hyponatremia is an independent risk factor for pneumonia and prolonged length of stay after ACDF.
确定颈椎前路融合与椎间盘切除术（ACDF）术前低钠血症与术后短期并发症及医疗资源利用（住院时间、再入院情况）之间的关联。
在美国外科医师学会国家外科质量改进计划数据库中识别接受ACDF手术的患者。排除接受翻修手术、创伤、椎体恶性肿瘤或感染的患者。血钠正常定义为钠（Na）水平在135至145 mEq/L之间，而低钠血症定义为Na < 135 mEq/L。术前，基于年龄、性别、美国麻醉医师协会评分和基线合并症，采用倾向评分匹配法将低钠血症患者与血钠正常患者按1:1进行匹配。轻微不良事件包括浅表感染、切口裂开、尿路感染、肺炎以及肾功能不全或衰竭。严重不良事件包括深部伤口感染、再次插管、肺栓塞、脑血管意外、心脏骤停、深静脉血栓形成、脓毒症、返回手术室以及30天内死亡。采用双变量分析和逻辑分析对并发症进行分析，显著性设定为P < 0.05。
在9094例接受ACDF手术的患者中，3.64%（n = 331）术前存在低钠血症。术前低钠血症是ACDF术后肺炎的独立危险因素（比值比[OR]，4.47；P = 0.020），也是住院时间延长超过均值1个标准差的独立危险因素（OR，1.71；P = 0.042）。术前低钠血症是发生严重不良事件（OR，2.40；P = 0.005）和任何不良事件（OR，2.44；P = 0.009）的独立危险因素。
术前低钠血症是ACDF术后肺炎和住院时间延长的独立危险因素。
