微创腰椎减压术后未达到最小临床重要差异的危险因素。
Risk Factors for Failing to Reach a Minimal Clinically Important Difference Following Minimally Invasive Lumbar Decompression.
作者信息
Cha Elliot D K, Lynch Conor P, Geoghegan Cara E, Jadczak Caroline N, Mohan Shruthi, Singh Kern
机构信息
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
出版信息
Int J Spine Surg. 2022 Feb;16(1):51-61. doi: 10.14444/8176. Epub 2022 Feb 17.
BACKGROUND
Clinically important postoperative changes can be best evaluated through the minimal clinically important difference (MCID). Our study aims to evaluate risk factors associated with failure to achieve MCID following lumbar decompression (LD).
METHODS
Demographics, perioperative characteristics, and patient-reported outcome measures (PROM) for pain, disability, and physical function were retrospectively reviewed and collected for patients undergoing LD. MCID achievement was calculated using established values. Relative risk of demographic and perioperative characteristics with failure to meet MCID for all PROMs was calculated. Least absolute shrinkage and selection operator (LASSO) was used to estimate individual risk factors, and postestimation logistic regression was performed.
RESULTS
The study cohort included 811 patients. Comorbidity burden was associated with failed MCID for visual analog scale (VAS) back and leg pain and Oswestry Disability Index (ODI). Operative levels or duration was associated with failed MCID for VAS leg pain, 12-item short form physical component summary (SF-12 PCS), and the patient-reported outcomes measurement information system physical function (PROMIS PF). Preoperative spinal pathology was associated with failed MCID for VAS leg pain, ODI, SF-12 PCS, and PROMIS PF. Additional risk factors included the type of operation, insurance, age, and body mass index. LASSO selected insurance, age, comorbidity burden, blood loss, operative duration, and type of spinal pathology as significant risk factors for failure to reach MCID.
CONCLUSION
Failure to reach MCID was greatest for VAS back. Age, comorbidity burden, and prolonged procedures were significantly associated with risk for failure to reach MCID for a majority of PROMs. Comorbidity burden combined with operative outcomes may place patients at increased risk for failure to reach MCID for pain, disability, and physical function following LD.
CLINICAL RELEVANCE
Establishes risk factors for failing to reach the threshold of meaningful difference in symptoms after LD surgery.
背景
临床上重要的术后变化可通过最小临床重要差异（MCID）得到最佳评估。我们的研究旨在评估腰椎减压术（LD）后未达到MCID的相关危险因素。
方法
对接受LD的患者的人口统计学、围手术期特征以及患者报告的疼痛、残疾和身体功能结局指标（PROM）进行回顾性审查和收集。使用既定值计算MCID的达成情况。计算所有PROM中未达到MCID的人口统计学和围手术期特征的相对风险。使用最小绝对收缩和选择算子（LASSO）来估计个体危险因素，并进行估计后的逻辑回归分析。
结果
研究队列包括811名患者。合并症负担与视觉模拟量表（VAS）背部和腿部疼痛以及奥斯威斯利残疾指数（ODI）未达到MCID相关。手术节段或手术时长与VAS腿部疼痛、12项简短健康调查量表身体成分总结（SF-12 PCS）以及患者报告结局测量信息系统身体功能（PROMIS PF）未达到MCID相关。术前脊柱病变与VAS腿部疼痛、ODI、SF-12 PCS和PROMIS PF未达到MCID相关。其他危险因素包括手术类型、保险类型、年龄和体重指数。LASSO选择保险类型、年龄、合并症负担、失血量、手术时长和脊柱病变类型作为未达到MCID的显著危险因素。
结论
VAS背部疼痛未达到MCID的情况最为严重。年龄、合并症负担和手术时间延长与大多数PROM未达到MCID的风险显著相关。合并症负担与手术结局相结合可能使患者在LD术后疼痛、残疾和身体功能方面未达到MCID的风险增加。
临床意义
确定了LD手术后症状未达到有意义差异阈值的危险因素。
Zotero 插件