Klimov Vladimir, Evsyukov Aleksey, Amelina Evgeniya, Ryabykh Sergey, Simonovich Alexander
European Medical Center, Moscow, Russia.
Department of Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia.
Front Surg. 2022 Apr 26;9:869345. doi: 10.3389/fsurg.2022.869345. eCollection 2022.
The use of minimally invasive surgery (MIS) results in fewer adverse and more improved outcomes. However, the literature data describing the factors increasing the number of complications, reoperation frequency and unscheduled re-hospitalizations in older patients after MIS are contradictory. In this study, a large number of patients was investigated for the complications of minimally invasive surgical treatment of degenerative disease of the lumbar spine in older patients. The objective of the study was to determine the predictors of unfavorable outcomes in such patients.
1,013 patients underwent MIS (decompression alone, TLIF, LLIF, ALIF) in 2013-2017. All operations were performed with the participation of the authors (neurosurgeons). The patient's average age was 66. The following data were collected: BMI; CCI; presence of postoperative complications according to the Dindo-Clavien classification; unplanned readmission at 90 days; hospital length of stay (LOS); surgical complexity (low, intermediate, and high); surgical time; and risk factors. The cumulative reoperation rate was determined at 5-years follow-up.
A total of 256 patients suffered a complication (25.2%), 226 classified as mild (grade I, II, IIIA), and 30 - as severe (IIIB, IVA). Such factors as the surgical complexity, BMI > 30, surgical time, number of operated levels were associated with a significant risk of developing a complication. For patients with and without complications, LOS was 9.3 and 6.3 days, respectively ( < 0.0001), the unplanned readmission rate was 1.3%. 104 patients underwent 133 revision operations. The 5-year cumulative reoperation rate was 15.2%, and the reoperation index was 12.1%. The CCI had no statistically significant effect on the complication incidence after MIS. A higher risk of complications was found in patients who underwent intermediate-complexity surgery (MIS TLIF) compared with uncompounded (decompression alone) and more complex (MIS LLIF, MIS ALIF) surgical procedures ( < 0.001 and = 0.001, respectively).
A register of postoperative complications is an important tool for health quality assessment and choosing the best surgical option that helps to establish measures to reduce such complications. Using MIS for the treatment of elderly patients reduces the number of severe complications.
微创手术（MIS）的应用可减少不良后果并改善更多结局。然而，关于增加老年患者微创手术后并发症数量、再次手术频率和非计划再次住院的因素，文献数据相互矛盾。在本研究中，对大量老年患者腰椎退行性疾病微创手术治疗的并发症进行了调查。本研究的目的是确定此类患者不良结局的预测因素。
2013年至2017年，1013例患者接受了MIS手术（单纯减压、经椎间孔腰椎椎体间融合术（TLIF）、斜外侧腰椎椎间融合术（LLIF）、前路腰椎椎间融合术（ALIF））。所有手术均在作者（神经外科医生）参与下进行。患者平均年龄为66岁。收集了以下数据：体重指数（BMI）；Charlson合并症指数（CCI）；根据Dindo-Clavien分类法的术后并发症情况；90天内的非计划再入院情况；住院时间（LOS）；手术复杂性（低、中、高）；手术时间；以及危险因素。在5年随访时确定累积再次手术率。
共有256例患者出现并发症（25.2%），其中226例为轻度（I、II、IIIA级），30例为重度（IIIB、IVA级）。手术复杂性、BMI>30、手术时间、手术节段数量等因素与发生并发症的显著风险相关。有并发症和无并发症患者的住院时间分别为9.3天和6.3天（<0.0001），非计划再入院率为1.3%。104例患者接受了133次翻修手术。5年累积再次手术率为15.2%，再次手术指数为12.1%。CCI对MIS术后并发症发生率无统计学显著影响。与单纯减压（未合并）和更复杂的手术（MIS LLIF、MIS ALIF）相比，接受中等复杂性手术（MIS TLIF）的患者发生并发症的风险更高（分别为<0.001和=0.001）。
术后并发症登记是健康质量评估和选择最佳手术方案的重要工具，有助于制定减少此类并发症的措施。使用MIS治疗老年患者可减少严重并发症的数量。
