Department of Neurologic Surgery, Rochester, MN, USA; Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
Department of Neurologic Surgery, Rochester, MN, USA.
Clin Neurol Neurosurg. 2022 Jun;217:107245. doi: 10.1016/j.clineuro.2022.107245. Epub 2022 Apr 14.
Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure on the cervical spine. While the procedure is generally well tolerated, respiratory and pulmonary complications (RPC) are an unlikely yet possible complication following ACDF. Few previous studies have specifically identified risk factors associated with RPC following ACDF. As the incidence of an RPC is rare at a single institution, a large national database is required for meaningful analysis.
The goal of this study is to characterize the predictors for RPC following an ACDF by utilizing a large national database.
The National Inpatient Sample (NIS) was queried from 2016 to 2018 for all patients who had received elective ACDF for degenerative cervical spine disease. We categorized several complications as airway complications including various abscess, angioedema, laryngeal edema, vocal cord paralysis, dysphonia, various etiologies of pneumonia, and acute respiratory distress syndrome. A Firth's logistic regression model was used to identify predictors of RPC.
We identified a final cohort of 52,575 admissions in which an ACDF was performed of which 1454 admissions had an RPC. Older patients were 1.03 times more likely to have an RPC (OR = 1.03, 95%CI: 1.02-1.04). African American patients compared to Caucasian patients were 1.44 times more likely to have an RPC (OR = 1.44, 95%CI: 1.23-1.68). Obese patients were found to be 1.64 to have an RPC (OR = 1.64, 95%CI: 1.45-1.85). Diabetic patients are 2.07 times more likely to have an RPC (OR = 2.07, 95%CI: 1.76-2.44). Hypertensive patients are 1.91 times more likely to have an RPC (OR = 1.91, 95%CI: 1.59-2.27). Urban based hospitals were 1.11 and 1.46 times more likely to have an RPC (OR = 1.11, 95%CI: 0.79-1.59; OR = 1.46, 95%CI: 1.06-2.08; teaching and non-teaching respectively). Patients who underwent multilevel procedure were 1.32 times more likely to experience a follow-on RPC (OR = 1.32, 95%CI: 1.17-1.49) DISCUSSION: Our study identified modifiable predictors of RPC after elective ACDF (e.g. obesity, diabetes) which can be used to guide preoperative patient optimization.
颈椎前路椎间盘切除融合术（ACDF）是颈椎的一种常见手术。虽然该手术通常耐受性良好，但呼吸和肺部并发症（RPC）是 ACDF 后可能发生但不太可能发生的并发症。先前的几项研究专门确定了与 ACDF 后 RPC 相关的风险因素。由于单个机构发生 RPC 的发生率较低，因此需要一个大型的国家数据库进行有意义的分析。
本研究旨在利用大型国家数据库，描述 ACDF 后 RPC 的预测因素。
2016 年至 2018 年，从国家住院患者样本（NIS）中查询了所有因退行性颈椎疾病接受择期 ACDF 的患者。我们将几种并发症归类为气道并发症，包括各种脓肿、血管性水肿、喉水肿、声带麻痹、声音嘶哑、各种病因的肺炎和急性呼吸窘迫综合征。使用 Firth 逻辑回归模型来确定 RPC 的预测因素。
我们确定了最终的 52575 例入院患者队列，其中 1454 例入院患者发生 RPC。年龄较大的患者发生 RPC 的可能性增加 1.03 倍（OR = 1.03，95%CI：1.02-1.04）。与白人患者相比，非裔美国患者发生 RPC 的可能性增加 1.44 倍（OR = 1.44，95%CI：1.23-1.68）。肥胖患者发生 RPC 的可能性增加 1.64 倍（OR = 1.64，95%CI：1.45-1.85）。糖尿病患者发生 RPC 的可能性增加 2.07 倍（OR = 2.07，95%CI：1.76-2.44）。高血压患者发生 RPC 的可能性增加 1.91 倍（OR = 1.91，95%CI：1.59-2.27）。基于城市的医院发生 RPC 的可能性分别增加 1.11 倍和 1.46 倍（OR = 1.11，95%CI：0.79-1.59；OR = 1.46，95%CI：1.06-2.08；分别为教学医院和非教学医院）。接受多节段手术的患者发生后续 RPC 的可能性增加 1.32 倍（OR = 1.32，95%CI：1.17-1.49）。讨论：我们的研究确定了可改变的 ACDF 后 RPC 预测因素（例如肥胖、糖尿病），可用于指导术前患者优化。
