Agarwal Nitin, Blitstein Jacob, Lui Austin, Torres-Espin Abel, Vasnarungruengkul Chalisar, Burke John, Mummaneni Praveen V, Dhall Sanjay S, Weinstein Philip R, Duong-Fernandez Xuan, Chou Austin, Pan Jonathan, Singh Vineeta, Ferguson Adam R, Hemmerle Debra D, Kyritsis Nikos, Talbott Jason F, Whetstone William D, Bresnahan Jacqueline C, Beattie Michael S, Manley Geoffrey T, DiGiorgio Anthony
1Departments of Neurological Surgery.
2College of Osteopathic Medicine, Touro University California, Vallejo.
J Neurosurg Spine. 2023 Mar 17:1-9. doi: 10.3171/2023.2.SPINE221043.
Increasing life expectancy has led to an older population. In this study, the authors analyzed complications and outcomes in elderly patients following spinal cord injury (SCI) using the established multi-institutional prospective study Transforming Research and Clinical Knowledge in SCI (TRACK-SCI) database collected in the Department of Neurosurgical Surgery at the University of California, San Francisco.
TRACK-SCI was queried for elderly individuals (≥ 65 years of age) with traumatic SCI from 2015 to 2019. Primary outcomes of interest included total hospital length of stay, perioperative complications, postoperative complications, and in-hospital mortality. Secondary outcomes included disposition location, and neurological improvement based on the American Spinal Injury Association Impairment Scale (AIS) grade at discharge. Descriptive analysis, Fisher's exact test, univariate analysis, and multivariable regression analysis were performed.
The study cohort consisted of 40 elderly patients. The in-hospital mortality rate was 10%. Every patient in this cohort experienced at least 1 complication, with a mean of 6.6 separate complications (median 6, mode 4). The most common complication categories were cardiovascular, with a mean of 1.6 complications (median 1, mode 1), and pulmonary, with a mean of 1.3 (median 1, mode 0) complications, with 35 patients (87.5%) having at least 1 cardiovascular complication and 25 (62.5%) having at least 1 pulmonary complication. Overall, 32 patients (80%) required vasopressor treatment for mean arterial pressure (MAP) maintenance goals. The use of norepinephrine correlated with increased cardiovascular complications. Only 3 patients (7.5%) of the total cohort had an improved AIS grade compared with their acute level at admission.
Given the increased frequency of cardiovascular complications associated with vasopressor use in elderly SCI patients, caution is warranted when targeting MAP goals in these patients. A downward adjustment of blood pressure maintenance goals and prophylactic cardiology consultation to select the most appropriate vasopressor agent may be advisable for SCI patients ≥ 65 years of age.
预期寿命的延长导致了人口老龄化。在本研究中，作者利用加利福尼亚大学旧金山分校神经外科收集的多机构前瞻性研究“脊髓损伤转化研究与临床知识”（TRACK-SCI）数据库，分析了老年脊髓损伤（SCI）患者的并发症及预后情况。
对TRACK-SCI数据库中2015年至2019年期间年龄≥65岁的创伤性SCI老年患者进行查询。主要关注的结局包括总住院时长、围手术期并发症、术后并发症及住院死亡率。次要结局包括出院安置地点以及基于美国脊髓损伤协会损伤量表（AIS）分级的出院时神经功能改善情况。进行了描述性分析、Fisher精确检验、单因素分析及多变量回归分析。
研究队列由40例老年患者组成。住院死亡率为10%。该队列中的每位患者至少经历了1种并发症，平均有6.6种不同并发症（中位数为6，众数为4）。最常见的并发症类别为心血管方面，平均有1.6种并发症（中位数为1，众数为1），以及肺部方面，平均有1.3种（中位数为1，众数为0）并发症，35例患者（87.5%）至少有1种心血管并发症，25例（62.5%）至少有1种肺部并发症。总体而言，32例患者（80%）需要使用血管升压药来维持平均动脉压（MAP）目标。去甲肾上腺素的使用与心血管并发症增加相关。与入院时急性损伤水平相比，整个队列中只有3例患者（7.5%）的AIS分级有所改善。
鉴于老年SCI患者使用血管升压药会增加心血管并发症的发生频率，因此在为这些患者设定MAP目标时应谨慎。对于≥65岁的SCI患者，可能建议下调血压维持目标，并进行预防性心脏病学会诊以选择最合适的血管升压药。
