肥胖与胸腰椎后路翻修手术患者围手术期不良事件。
Obesity and perioperative adverse events in patients undergoing complex revision surgery for the thoracolumbar spine.
机构信息
Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, 77030, USA.
Texas A&M University Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA.
出版信息
BMC Musculoskelet Disord. 2022 Jun 4;23(1):534. doi: 10.1186/s12891-022-05505-4.
BACKGROUND
There are no previous studies that evaluate the effect of obesity on patients undergoing complex revision thoracolumbar spine surgery. The primary objective was to determine the relationship between obesity and perioperative adverse events (AEs) with patients undergoing complex revision thoracolumbar spine surgery while controlling for psoas muscle index (PMI) as a confounding variable. The secondary objective was to determine the relationship between obesity and 30-day readmission rates, 30-day re-operation rates, rate of discharge to a facility, and post-operative length of stay (LOS).
METHODS
Between May 2016 and February 2020, a retrospective analysis of individuals undergoing complex revision surgery of the thoracolumbar spine was performed at a single institution. Obesity was defined as BMI ≥ 30.0 kg/m. PMI < 500 mm/m for males and < 412 mm/m for females were used to define low muscle mass. A Spine Surgical Invasiveness Index (SSII) > 10 was used to define complex revision surgery. A multivariable logistic regression model was used to ascertain the effects of low muscle mass, obesity, age, and gender on the likelihood of the occurrence of any AE.
RESULTS
A total of 114 consecutive patients were included in the study. Fifty-four patients were in the obese cohort and 60 patients in the non-obese cohort. There was not a significant difference in perioperative outcomes of both the obese and non-obese patients. There were 22 obese patients (40.7%) and 33 non-obese patients (55.0%) that experienced any AE (p = 0.130). Multivariable analysis demonstrated that individuals with low muscle mass had a significantly higher likelihood for an AE than individuals with normal or high muscle mass (OR: 7.53, 95% CI: 3.05-18.60). Obesity did not have a significant effect in predicting AEs.
CONCLUSIONS
Obesity is not associated with perioperative AEs, 30-day readmission rates, 30-day re-operation rates, rate of discharge to a facility, or post-operative length of stay (LOS) among patients undergoing complex revision thoracolumbar spine surgery.
LEVEL OF EVIDENCE
III.
背景
目前尚无研究评估肥胖对接受复杂胸腰椎脊柱翻修手术患者的影响。本研究的主要目的是在控制腰大肌指数（PMI）这一混杂变量的情况下，确定肥胖与复杂胸腰椎脊柱翻修手术围手术期不良事件（AE）之间的关系。次要目的是确定肥胖与 30 天内再入院率、30 天内再次手术率、出院去向和术后住院时间（LOS）之间的关系。
方法
本研究为单中心回顾性研究，纳入 2016 年 5 月至 2020 年 2 月期间接受复杂胸腰椎脊柱翻修手术的患者。肥胖定义为 BMI≥30.0kg/m。男性 PMI<500mm/m，女性 PMI<412mm/m 定义为低肌肉量。脊柱手术侵袭性指数（SSII）>10 定义为复杂翻修手术。多变量逻辑回归模型用于确定低肌肉量、肥胖、年龄和性别对任何 AE 发生可能性的影响。
结果
共纳入 114 例连续患者。其中肥胖组 54 例，非肥胖组 60 例。肥胖组和非肥胖组患者的围手术期结果无显著差异。肥胖组 22 例（40.7%）和非肥胖组 33 例（55.0%）患者发生任何 AE（p=0.130）。多变量分析显示，低肌肉量患者发生 AE 的可能性明显高于正常或高肌肉量患者（OR：7.53，95%CI：3.05-18.60）。肥胖并不能显著预测 AE 的发生。
结论
肥胖与接受复杂胸腰椎脊柱翻修手术患者的围手术期 AE、30 天内再入院率、30 天内再次手术率、出院去向或术后 LOS 无关。
证据等级
III 级。
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