Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania.
McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia.
Clin Spine Surg. 2023 Dec 1;36(10):E423-E429. doi: 10.1097/BSD.0000000000001504. Epub 2023 Jul 31.
Retrospective cohort.
The present study analyzes the impact of end-overlap on short-term outcomes after single-level, posterior lumbar fusions.
Few studies have evaluated how "end-overlap" (i.e., surgical overlap after the critical elements of spinal procedures, such as during wound closure) influences surgical outcomes.
Retrospective analysis was performed on 3563 consecutive adult patients undergoing single-level, posterior-only lumbar fusion over a 6-year period at a multi-hospital university health system. Exclusion criteria included revision surgery, missing key health information, significantly elevated body mass index (>70), non-elective operations, non-general anesthesia, and unclean wounds. Outcomes included 30-day emergency department visit, readmission, reoperation, morbidity, and mortality. Univariate analysis was carried out on the sample population, then limited to patients with end-overlap. Subsequently, patients with the least end-overlap were exact-matched to patients with the most. Matching was performed based on key demographic variables-including sex and comorbid status-and attending surgeon, and then outcomes were compared between exact-matched cohorts.
Among the entire sample population, no significant associations were found between the degree of end-overlap and short-term adverse events. Limited to cases with any end-overlap, increasing overlap was associated with increased 30-day emergency department visits ( P =0.049) but no other adverse outcomes. After controlling for confounding variables in the demographic-matched and demographic/surgeon-matched analyses, no differences in outcomes were observed between exact-matched cohorts.
The degree of overlap after the critical steps of single-level lumbar fusion did not predict adverse short-term outcomes. This suggests that end-overlap is a safe practice within this surgical population.
回顾性队列研究。
本研究分析了单节段后路腰椎融合术后端重叠对短期结果的影响。
很少有研究评估“端重叠”（即在脊柱手术的关键步骤完成后进行手术重叠，例如在伤口关闭期间）如何影响手术结果。
对 6 年内在多医院大学健康系统接受单节段后路腰椎融合术的 3563 例连续成年患者进行回顾性分析。排除标准包括翻修手术、关键健康信息缺失、明显升高的体重指数（>70）、非选择性手术、非全身麻醉和伤口不洁。结果包括 30 天内急诊就诊、再入院、再次手术、发病率和死亡率。对样本人群进行单变量分析，然后仅限于有端重叠的患者。随后，将重叠最少的患者与重叠最多的患者进行精确匹配。基于关键人口统计学变量（包括性别和合并症状况）和主治医生进行匹配，然后比较精确匹配队列之间的结果。
在整个样本人群中，端重叠程度与短期不良事件之间没有显著关联。在有任何端重叠的情况下进行限制，重叠增加与 30 天内急诊就诊增加相关（P=0.049），但其他不良结局没有增加。在人口统计学匹配和人口统计学/外科医生匹配分析中控制混杂变量后，精确匹配队列之间的结果没有差异。
单节段腰椎融合术关键步骤后的重叠程度并不能预测短期不良结局。这表明在该手术人群中，端重叠是一种安全的做法。
