Farooqi Ali S, Borja Austin J, Jabarkheel Rashad, Glauser Gregory, Strouz Krista, McClintock Scott D, Malhotra Neil R
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, Pennsylvania, USA.
World Neurosurg. 2022 Dec;168:e76-e86. doi: 10.1016/j.wneu.2022.09.028. Epub 2022 Sep 10.
The American College of Surgeons (ACS) updated its guidelines on overlapping surgery in 2016. The objective was to examine differences in postoperative outcomes after overlapping surgery either pre-ACS guideline revision or post-guideline revision, in a coarsened exact matching sample.
A total of 3327 consecutive adult patients undergoing single-level posterior lumbar fusion from 2013 to 2019 were retrospectively analyzed. Patients were separated into a pre-ACS guideline revision cohort (surgery before April 2016) or a post-guideline revision cohort (surgery after October 2016) for comparison. The primary outcomes were proportion of cases performed with any degree of overlap, and adverse events including 30-day and 90-day rates of readmission, reoperation, emergency department visit, morbidity, and mortality. Subsequently, coarsened exact matching was used among overlapping surgery patients only to assess the impact of the ACS guideline revision on overlapping outcomes, and controlling for attending surgeon and key patient characteristics known to affect surgical outcomes.
After the implementation of the ACS guidelines, fewer cases were performed with overlap (22.0% vs. 53.7%; P < 0.001). Patients in the post-ACS guideline revision cohort experienced improved rates of readmission and reoperation within 30 and 90 days. However, when limited to overlapping cases only, no differences were observed in overlap outcomes pre-ACS versus post-ACS guideline revision. Similarly, when exact matched on risk-associated patient characteristics and attending surgeon, overlapping surgery patients pre-ACS and post-ACS guideline revision experienced similar rates of 30-day and 90-day outcomes.
After the ACS guideline revision, no discernable impact was observed on postoperative outcomes after lumbar fusion performed with overlap.
美国外科医师学会（ACS）于2016年更新了其关于重叠手术的指南。目的是在一个粗化精确匹配样本中，研究ACS指南修订前或修订后重叠手术后的术后结果差异。
回顾性分析了2013年至2019年期间连续接受单节段后路腰椎融合术的3327例成年患者。将患者分为ACS指南修订前队列（2016年4月前手术）或指南修订后队列（2016年10月后手术）进行比较。主要结局包括进行任何程度重叠手术的病例比例，以及不良事件，包括30天和90天的再入院率、再次手术率、急诊就诊率、发病率和死亡率。随后，仅在重叠手术患者中使用粗化精确匹配来评估ACS指南修订对重叠手术结果的影响，并控制主刀医生和已知会影响手术结果的关键患者特征。
ACS指南实施后，进行重叠手术的病例减少（22.0%对53.7%；P<0.001）。ACS指南修订后队列中的患者在30天和90天内的再入院率和再次手术率有所改善。然而，仅局限于重叠病例时，ACS指南修订前和修订后的重叠手术结果未观察到差异。同样，当根据风险相关的患者特征和主刀医生进行精确匹配时，ACS指南修订前和修订后的重叠手术患者在30天和90天的结果发生率相似。
ACS指南修订后，未观察到对重叠进行的腰椎融合术后的术后结果有明显影响。
