Kim Jihye, Ryu Hwan, Kim Tae-Hwan
Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea.
Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea.
J Clin Med. 2022 Jun 10;11(12):3338. doi: 10.3390/jcm11123338.
Reoperation is a major concern in spinal fusion surgery for degenerative spinal disease. Earlier reported reoperation rates were confined to a specific spinal region without comprehensive analysis, and their prediction models for reoperation were not statistically validated. Our study aimed to present reasonable base rates for reoperation according to all possible risk factors and build a validated prediction model for early reoperation. In our nationwide population-based cohort study, data between 2014 and 2016 were obtained from the Korean National Health Insurance claims database. Patients older than 19 years who underwent instrumented spinal fusion surgery for degenerative spinal diseases were included. The patients were divided into cases (patients who underwent reoperation) and controls (patients who did not undergo reoperation), and risk factors for reoperation were determined by multivariable analysis. The estimates of all statistical models were internally validated using bootstrap samples, and sensitivity analyses were additionally performed to validate the estimates by comparing the two prediction models (models for 1st-year and 3rd-year reoperation). The study included 65,355 patients: 2939 (4.5%) who underwent reoperation within 3 years after the index surgery and 62,146 controls. Reoperation rates were significantly different according to the type of surgical approach and the spinal region. The third-year reoperation rates were 5.3% in the combined lumbar approach, 5.2% in the posterior lumbar approach, 5.0% in the anterior lumbar approach, 3.0% in the posterior thoracic approach, 2.8% in the posterior cervical approach, 2.6% in the anterior cervical approach, and 1.6% in the combined cervical approach. Multivariable analysis identified older age, male sex, hospital type, comorbidities, allogeneic transfusion, longer use of steroids, cages, and types of surgical approaches as risk factors for reoperation. Clinicians can conduct comprehensive risk assessment of early reoperation in patients who will undergo instrumented spinal fusion surgery for degenerative spinal disease using this model.
再次手术是退行性脊柱疾病脊柱融合手术中的一个主要问题。早期报道的再次手术率局限于特定脊柱区域，缺乏全面分析，且其再次手术预测模型未经过统计学验证。我们的研究旨在根据所有可能的风险因素给出合理的再次手术基础发生率，并建立一个经过验证的早期再次手术预测模型。在我们基于全国人群的队列研究中，2014年至2016年的数据来自韩国国民健康保险理赔数据库。纳入了19岁以上因退行性脊柱疾病接受器械辅助脊柱融合手术的患者。将患者分为病例组（接受再次手术的患者）和对照组（未接受再次手术的患者），通过多变量分析确定再次手术的风险因素。所有统计模型的估计值通过自抽样进行内部验证，并额外进行敏感性分析，通过比较两个预测模型（第1年和第3年再次手术模型）来验证估计值。该研究纳入了65355例患者：其中索引手术后3年内接受再次手术的有2939例（4.5%），对照组有62146例。根据手术入路类型和脊柱区域，再次手术率有显著差异。联合腰椎入路的第3年再次手术率为5.3%，后外侧腰椎入路为5.2%，前路腰椎入路为5.0%，后外侧胸椎入路为3.0%，后外侧颈椎入路为2.8%，前路颈椎入路为2.6%，联合颈椎入路为1.6%。多变量分析确定年龄较大、男性、医院类型、合并症、异体输血、较长时间使用类固醇、椎间融合器以及手术入路类型为再次手术的风险因素。临床医生可以使用该模型对因退行性脊柱疾病将接受器械辅助脊柱融合手术的患者进行早期再次手术的综合风险评估。
