成人脊柱畸形矫正术后伴自身免疫性疾病患者的医疗并发症。
Medical complications following adult spinal deformity correction in patients with autoimmune disease.
机构信息
1Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu.
3Department of Orthopedics, The Medical City, Ortigas Avenue, Pasig City, Philippines.
出版信息
J Neurosurg Spine. 2023 Apr 7;39(1):65-74. doi: 10.3171/2023.2.SPINE221392. Print 2023 Jul 1.
OBJECTIVE
An aberrant inflammatory response, which plays a role in the development of postoperative complications, is observed in autoimmune diseases, Yet, there is a paucity of literature regarding the effects of autoimmune diseases after adult spinal deformity (ASD) surgery. The goal of this study was to determine the effects of autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus) on postoperative medical complications, patient-reported outcome measures (PROMs), and radiographic alignment in patients who underwent ASD surgery.
METHODS
Propensity-score matching for age and sex was performed for patients with autoimmune disease (group A) and nonautoimmune patients (group NA1). Postoperative medical complications, preoperative and 2-year follow-up PROMs, and preoperative, immediate postoperative, and 2-year follow-up radiographic alignment were evaluated.
RESULTS
Among 386 patients (27 in group A and 359 in group NA1), autoimmune patients had a higher incidence of respiratory complications (11.1% vs 2.2%, p = 0.036), gastrointestinal complications (14.8% vs 3.1%, p = 0.016), urinary tract infections (14.8% vs 3.1%, p = 0.016), cholecystitis (7.4% vs 0%, p = 0.005), and fever of unknown origin (14.8% vs 0%, p < 0.001). Autoimmune patients had worse preoperative ODI (54.2 vs 44.7, p = 0.004) and 2-year follow-up Scoliosis Research Society 22-item Questionnaire (SRS-22) scores (3.1 vs 3.5, p = 0.039), with higher preoperative sacral slope (23.4° vs 17.8°, p = 0.020). Propensity-score matching for age and sex yielded 27 pairs (group A and group NA2). Having at least one medical complication (group A 74.1% vs group NA2 22.2%, p < 0.001), total complications per person (1.3 vs 0.3, p = 0.010), prognostic nutrition index (44.8 vs 48.6, p = 0.034), steroid use (51.9% vs 0%, p < 0.001), immunosuppressant use (48.1% vs 0%, p < 0.001), length of hospital stay (38 vs 27 days, p = 0.018), and discharge to care facility (29.6% vs 7.4%, p = 0.036) were higher in group A. Preoperative ODI (54.2 vs 43.2, p = 0.011) and 2-year follow-up SRS-22 scores (3.1 vs 3.6 p = 0.019) were worse in group A. No differences were observed in radiographic alignment.
CONCLUSIONS
Patients with autoimmune disease had higher complication rates and worse PROMs following ASD surgery in this study. There was no difference in spinal alignment compared with controls. Multidisciplinary planning and full disclosure of possible adverse effects should be completed prior to correction of ASD in patients with autoimmune disease.
目的
自身免疫性疾病患者存在异常的炎症反应，这在术后并发症的发展中起作用。然而，关于成年脊柱畸形（ASD）手术后自身免疫性疾病的影响，文献却很少。本研究的目的是确定自身免疫性疾病（类风湿关节炎、系统性红斑狼疮）对接受 ASD 手术患者的术后医疗并发症、患者报告的结局测量（PROM）和影像学矫正的影响。
方法
对患有自身免疫性疾病的患者（组 A）和非自身免疫性患者（组 NA1）进行年龄和性别倾向评分匹配。评估术后医疗并发症、术前和 2 年随访的 PROMs 以及术前、即刻术后和 2 年随访的影像学矫正。
结果
在 386 例患者中（组 A 27 例，组 NA1 359 例），自身免疫性患者的呼吸道并发症发生率较高（11.1%比 2.2%，p=0.036）、胃肠道并发症（14.8%比 3.1%，p=0.016）、尿路感染（14.8%比 3.1%，p=0.016）、胆囊炎（7.4%比 0%，p=0.005）和不明原因发热（14.8%比 0%，p<0.001）。自身免疫性患者的术前 ODI（54.2 比 44.7，p=0.004）和 2 年随访的 SRS-22 问卷评分（3.1 比 3.5，p=0.039）更差，术前骶骨倾斜度更高（23.4°比 17.8°，p=0.020）。年龄和性别倾向评分匹配产生了 27 对（组 A 和组 NA2）。至少有一种医疗并发症（组 A 74.1%比组 NA2 22.2%，p<0.001）、每人并发症总数（1.3 比 0.3，p=0.010）、预后营养指数（44.8 比 48.6，p=0.034）、类固醇使用（51.9%比 0%，p<0.001）、免疫抑制剂使用（48.1%比 0%，p<0.001）、住院时间（38 比 27 天，p=0.018）和出院到护理机构（29.6%比 7.4%，p=0.036）在组 A 更高。组 A 的术前 ODI（54.2 比 43.2，p=0.011）和 2 年随访的 SRS-22 评分（3.1 比 3.6，p=0.019）更差。在影像学矫正方面没有差异。
结论
在这项研究中，患有自身免疫性疾病的患者在接受 ASD 手术后并发症发生率更高，PROMs 更差。与对照组相比，脊柱矫正没有差异。在纠正自身免疫性疾病患者的 ASD 之前，应进行多学科规划并充分披露可能的不良影响。
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