Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA; New York Spine Institute, New York, NY, USA.
Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA; New York Spine Institute, New York, NY, USA.
J Clin Neurosci. 2022 Jan;95:112-117. doi: 10.1016/j.jocn.2021.11.032. Epub 2021 Dec 9.
Myocardial infarction (MI), and its predictive factors, has been an understudied complication following spine operations. The objective was to assess the risk factors for perioperative MI in elective spine surgery patients as a retrospective case control study. Elective spine surgery patients with a perioperative MI were isolated in the NSQIP. The relationship between MI and non-MI spine patients was assessed using chi-squared and independent samples t-tests. Univariate/multivariate analyses assessed predictive factors of MI. Logistic regression with stepwise model selection was employed to create a model to predict MI occurrence. The study included 196,523 elective spine surgery patients (57.1 yrs, 48%F, 30.4 kg/m), and 436 patients with acute MI (Spine-MI). Incidence of MI did not change from 2010 to 2016 (0.2%-0.3%, p = 0.298). Spine-MI patients underwent more fusions than patients without MI (73.6% vs 58.4%, p < 0.001), with an average of 1.03 levels fused. Spine-MI patients also had significantly more SPO (5.0% vs 1.8%, p < 0.001) and 3CO (0.9% vs 0.2%, p < 0.001), but less decompression-only procedures (26.4% vs 41.6%, p < 0.001). Spine-MI underwent more revisions (5.3% vs 2.9%, p = 0.003), had greater invasiveness scores (3.41 vs 2.73, p < 0.001) and longer operative times (211.6 vs 147.3 min, p < 0.001). Mortality rate for Spine-MI patients was 4.6% versus 0.05% (p < 0.001). Multivariate modeling for Spine-MI predictors yielded an AUC of 83.7%, and included history of diabetes, cardiac arrest and PVD, past blood transfusion, dialysis-dependence, low preoperative platelet count, superficial SSI and days from operation to discharge. A model with good predictive capacity for MI after spine surgery now exists and can aid in risk-stratification of patients, consequently improving preoperative patient counseling and optimization in the peri-operative period.
心肌梗死（MI）及其预测因素一直是脊柱手术后研究不足的并发症。本研究旨在评估择期脊柱手术患者围手术期 MI 的危险因素，这是一项回顾性病例对照研究。在 NSQIP 中，孤立出围手术期发生 MI 的择期脊柱手术患者。使用卡方检验和独立样本 t 检验评估 MI 与非 MI 脊柱患者之间的关系。单变量/多变量分析评估 MI 的预测因素。采用逐步模型选择的逻辑回归建立预测 MI 发生的模型。该研究纳入了 196523 例择期脊柱手术患者（57.1 岁，48%为女性，30.4kg/m²）和 436 例急性 MI 患者（脊柱-MI）。从 2010 年到 2016 年，MI 的发生率没有变化（0.2%-0.3%，p=0.298）。与无 MI 的患者相比，脊柱-MI 患者接受了更多的融合术（73.6% vs 58.4%，p<0.001），平均融合 1.03 个节段。脊柱-MI 患者还具有显著更多的 SPO（5.0% vs 1.8%，p<0.001）和 3CO（0.9% vs 0.2%，p<0.001），但较少进行单纯减压手术（26.4% vs 41.6%，p<0.001）。脊柱-MI 患者接受了更多的翻修手术（5.3% vs 2.9%，p=0.003），手术侵袭性评分更高（3.41 vs 2.73，p<0.001），手术时间更长（211.6 分钟 vs 147.3 分钟，p<0.001）。脊柱-MI 患者的死亡率为 4.6%，而 0.05%（p<0.001）。脊柱-MI 预测因素的多变量建模产生了 83.7%的 AUC，包括糖尿病史、心脏骤停和 PVD、既往输血、透析依赖、术前血小板计数低、浅表 SSI 和从手术到出院的天数。目前已经建立了一种预测脊柱手术后 MI 的能力良好的模型，可用于对患者进行风险分层，从而改善术前患者咨询和围手术期的优化。
