From the Department of Orthopaedic Surgery (Cummins, Callahan, Scheffler, and Theologis) and Department of Epidemiology & Biostatistics, University of California-San Francisco (UCSF) (Scheffler), San Francisco, CA.
J Am Acad Orthop Surg. 2022 May 15;30(10):476-483. doi: 10.5435/JAAOS-D-21-00643. Epub 2022 Feb 22.
The purpose of this study wasto evaluate cause-specific 5-year revision rates and risk factors for revision after elective multilevel lumbar instrumented fusion in older patients.
Older patients (>60 years) who underwent elective multilevel (3+) lumbar instrumented fusions were identified in Healthcare Cost and Utilization Project state inpatient databases and followed for 5 years for revision operations because of mechanical failure, degenerative disease (DD), infection, postlaminectomy syndrome, and stenosis. Cox proportional hazards multivariate analyses were conducted to determine risk factors associated with revision for each diagnostic cause.
The cohort included 5,636 patients (female-3,285; average age-71.6 years). Most of the operations were 3 to 7 levels (97.4%), and the mean length of stay was 5.4 days. The overall 5-year revision rate was 16.5% with predominant etiologies of DD (50.7%), mechanical failure (32.2%), and stenosis (8.0%). The revision procedure at the index operation was associated with an increased revision risk for DD (hazards ratio [HR] = 1.59, 95% confidence interval [CI], 1.29 to 1.98, P < 0.001) and mechanical failure (HR = 1.56, 95% CI, 1.19 to 2.04, P = 0.020). Male sex was associated with a significantly reduced revision risk for DD (HR = 0.75, 95% CI, 0.62 to 0.91, P = 0.04). Age, race, and number of comorbidities had no notable effect on the overall or cause-specific risk of revision.
In this large database analysis, DD and mechanical failure were the most common etiologies comprising a 5-year revision rate of 16.5% after elective multilevel lumbar instrumented fusion in older patients. Revision operations and female patients carried the strongest risks for revision.
本研究旨在评估老年患者选择性多节段腰椎后路固定融合术后特定病因 5 年返修率和返修风险因素。
从 Healthcare Cost and Utilization Project 州立住院患者数据库中确定行选择性多节段（≥3 节）腰椎后路固定融合术的老年（＞60 岁）患者，并对其进行 5 年随访，因机械故障、退行性疾病（DD）、感染、椎板切除后综合征和狭窄而接受返修手术。采用 Cox 比例风险多变量分析确定与每种诊断病因相关的返修风险因素。
该队列包括 5636 例患者（女性 3285 例；平均年龄 71.6 岁）。大多数手术为 3 至 7 个节段（97.4%），平均住院时间为 5.4 天。总体 5 年返修率为 16.5%，主要病因为 DD（50.7%）、机械故障（32.2%）和狭窄（8.0%）。初次手术的返修手术与 DD（风险比[HR] = 1.59，95%置信区间[CI]，1.29 至 1.98，P＜0.001）和机械故障（HR = 1.56，95%CI，1.19 至 2.04，P = 0.020）的返修风险增加相关。男性与 DD 的返修风险显著降低相关（HR = 0.75，95%CI，0.62 至 0.91，P = 0.04）。年龄、种族和合并症数量对整体或特定病因的返修风险没有显著影响。
在这项大型数据库分析中，DD 和机械故障是最常见的病因，在老年患者选择性多节段腰椎后路固定融合术后 5 年返修率为 16.5%。返修手术和女性患者是返修的最强风险因素。
