Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 111 Suwannabhumi Canal Road, Bang Pla, Bang Phli District, Samut Prakan, 10540, Thailand.
Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Thung Phaya Thai, Ratchathewi District, Bangkok, 10400, Thailand.
Eur Spine J. 2023 May;32(5):1729-1740. doi: 10.1007/s00586-023-07638-z. Epub 2023 Mar 21.
Spinal metastasis surgeries carry substantial risk of complications. PRF is among complications that significantly increase mortality rate and length of hospital stay. The risk factor of PRF after spinal metastasis surgery has not been investigated. This study aims to identify the predictors of postoperative respiratory failure (PRF) and in-hospital death after spinal metastasis surgery.
We retrospectively reviewed consecutive patients with spinal metastasis surgically treated between 2008 and 2018. PRF was defined as mechanical ventilator dependence > 48 h postoperatively (MVD) or unplanned postoperative intubation (UPI). Collected data include demographics, laboratory data, radiographic and operative data, and postoperative complications. Stepwise logistic regression analysis was used to determine predictors independently associated with PRFs and in-hospital death.
This study included 236 patients (average age 57 ± 14 years, 126 males). MVD and UPI occurred in 13 (5.5%) patients and 13 (5.5%) patients, respectively. During admission, 14 (5.9%) patients had died postoperatively. Multivariate logistic regression analysis revealed significant predictors of MVD included intraoperative blood loss > 2000 mL (odds ratio [OR] 12.28, 95% confidence interval [CI] 2.88-52.36), surgery involving cervical spine (OR 9.58, 95% CI 1.94-47.25), and ASA classification ≥ 4 (OR 6.59, 95% CI 1.85-23.42). The predictive factors of UPI included postoperative sepsis (OR 20.48, 95% CI 3.47-120.86), central nervous system (CNS) metastasis (OR 10.21, 95% CI 1.42-73.18), lung metastasis (OR 7.18, 95% CI 1.09-47.4), and postoperative pulmonary complications (OR 6.85, 95% CI 1.44-32.52). The predictive factors of in-hospital death included postoperative sepsis (OR 13.15, 95% CI 2.92-59.26), CNS metastasis (OR 10.55, 95% CI 1.54-72.05), and postoperative pulmonary complications (OR 9.87, 95% CI 2.35-41.45).
PRFs and in-hospital death are not uncommon after spinal metastasis surgery. Predictive factors for PRFs included preoperative comorbidities, intraoperative massive blood loss, and postoperative complications. Identification of risk factors may help guide therapeutic decision-making and patient counseling.
脊柱转移瘤手术存在发生并发症的巨大风险。术后肺部并发症（PRF）显著增加死亡率和住院时间，是其中一种并发症。脊柱转移瘤手术后发生 PRF 的风险因素尚未得到研究。本研究旨在确定脊柱转移瘤手术后发生术后呼吸衰竭（PRF）和院内死亡的预测因素。
我们回顾性分析了 2008 年至 2018 年间连续接受脊柱转移瘤手术治疗的患者。PRF 定义为术后机械通气依赖>48 小时（MVD）或计划性术后插管（UPI）。收集的数据包括人口统计学、实验室数据、影像学和手术数据以及术后并发症。采用逐步逻辑回归分析确定与 PRF 和院内死亡独立相关的预测因素。
本研究纳入 236 例患者（平均年龄 57±14 岁，126 例男性）。13 例（5.5%）患者发生 MVD，13 例（5.5%）患者发生 UPI。住院期间，14 例（5.9%）患者术后死亡。多变量逻辑回归分析显示，MVD 的显著预测因素包括术中出血量>2000ml（比值比[OR] 12.28，95%置信区间[CI] 2.88-52.36）、颈椎手术（OR 9.58，95% CI 1.94-47.25）和 ASA 分级≥4 级（OR 6.59，95% CI 1.85-23.42）。UPI 的预测因素包括术后脓毒症（OR 20.48，95% CI 3.47-120.86）、中枢神经系统（CNS）转移（OR 10.21，95% CI 1.42-73.18）、肺转移（OR 7.18，95% CI 1.09-47.4）和术后肺部并发症（OR 6.85，95% CI 1.44-32.52）。院内死亡的预测因素包括术后脓毒症（OR 13.15，95% CI 2.92-59.26）、CNS 转移（OR 10.55，95% CI 1.54-72.05）和术后肺部并发症（OR 9.87，95% CI 2.35-41.45）。
脊柱转移瘤手术后 PRF 和院内死亡并不少见。PRF 的预测因素包括术前合并症、术中大量失血和术后并发症。确定风险因素可能有助于指导治疗决策和患者咨询。
