Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
Eur Spine J. 2023 Sep;32(9):3218-3229. doi: 10.1007/s00586-023-07845-8. Epub 2023 Jul 5.
The aim of this study is to identify the incidence, clinical features, and risk factors for postoperative acute pancreatitis (PAP) after lumbar surgery.
We retrospectively analyzed patients who developed PAP after posterior lumbar fusion surgery. For each PAP patient, data were collected for four controls who underwent procedures in the same period and did not develop PAP. Statistical methods included univariate and multivariate analyses.
Totally, 21 out of 20,929 patients were diagnosed with PAP (0.10%) after posterior lumbar fusion surgery. Patients with degenerative lumbar scoliosis were at higher risk of developing PAP (P < 0.05). With atypical clinical features, PAP occurred within 3 days (0-5) after surgery. PAP patients had significantly higher incidence of osteoporosis (47.6 vs. 22.6%, P = 0.030) and fusion of L1/2(42.9 vs. 4.3%, P = 0.010), lower albumin (42.2 ± 4.1 vs. 44.3 ± 3.2 g/L, P = 0.010), more fusion segments (median 4 vs. 3, P = 0.022), larger surgical invasiveness index (median 9 vs. 8, P = 0.007), longer operation duration (232 ± 109 vs. 185 ± 90 min, P = 0.041), greater estimated blood loss (median 600 vs. 400 mL, P = 0.025), lower intraoperative mean arterial pressure (87.2 ± 9.9 vs. 92.1 ± 8.8 mmHg, P = 0.024). Multivariate logistic regression analysis found three independent risk factors: fusion of L1/2, surgical invasiveness index > 8, and intraoperative mean arterial pressure < 90 mmHg. All patients were treated with conservative therapy and fully recovered after 8.1 (4-22) days.
The incidence of PAP following posterior surgery for degenerative lumbar disease was 0.10%, and its clinical features were not typical. The fusion of L1/2, high surgical invasiveness index, and low intraoperative mean arterial pressure were independent risk factors for PAP after surgery for lumbar degenerative disease.
本研究旨在确定腰椎手术后急性胰腺炎（PAP）的发生率、临床特征和危险因素。
我们回顾性分析了接受后路腰椎融合术后发生 PAP 的患者。对于每位发生 PAP 的患者，我们收集了同期接受手术且未发生 PAP 的 4 名对照患者的数据。统计方法包括单因素和多因素分析。
总共 20929 例后路腰椎融合术后患者中有 21 例（0.10%）诊断为 PAP。退行性腰椎侧凸患者发生 PAP 的风险较高（P<0.05）。具有非典型临床特征的 PAP 发生在术后 3 天（0-5）内。PAP 患者的骨质疏松症发生率显著更高（47.6%比 22.6%，P=0.030），L1/2 融合发生率更高（42.9%比 4.3%，P=0.010），白蛋白水平更低（42.2±4.1 比 44.3±3.2 g/L，P=0.010），融合节段更多（中位数 4 比 3，P=0.022），手术侵袭性指数更大（中位数 9 比 8，P=0.007），手术时间更长（232±109 比 185±90 min，P=0.041），估计失血量更大（中位数 600 比 400 mL，P=0.025），术中平均动脉压更低（87.2±9.9 比 92.1±8.8 mmHg，P=0.024）。多因素 logistic 回归分析发现三个独立的危险因素：L1/2 融合、手术侵袭性指数>8、术中平均动脉压<90 mmHg。所有患者均接受保守治疗，8.1（4-22）天后完全康复。
退行性腰椎疾病后路手术后 PAP 的发生率为 0.10%，其临床特征不典型。L1/2 融合、高手术侵袭性指数和术中平均动脉压低是腰椎退行性疾病后路手术后发生 PAP 的独立危险因素。
