Hong Seung-Wan, Rhee Ka-Young, Kim Tae-Hoon, Kim Seong-Hyop
Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea.
Deparment of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea.
J Clin Med. 2023 Aug 16;12(16):5332. doi: 10.3390/jcm12165332.
There is a lack of studies on utilising skeletal muscle mass via preoperative lumbar computed tomography or magnetic resonance imaging as a predictor of postoperative complications of posterior lumbar interbody fusion (PLIF) surgery in elderly patients.
Patients aged >65 years who underwent PLIF were enrolled. The sum of the cross-sectional areas of the erector spinae muscles (CSA) was presented as the skeletal muscle mass. Postoperative complications were assessed using CSA, pulmonary function testing, and prognostic nutritional index (PNI).
Patients with postoperative complications showed significantly lower values of CSA (median 2266.70 (2239.73-2875.10) mm vs. 3060.30 (2749.25-3473.30) mm, < 0.001), functional vital capacity, forced expiratory volume at 1 s, and PNI. However, multiple logistic regression analysis identified American Society of Anaesthesiologists Physical Status (ASA PS) I (odds ratio 0.307 (95% confidence interval 0.110-0.852), = 0.023), ASA PS III (4.033 (1.586-10.254), = 0.003), CSA (0.999 (0.999-1.000), < 0.001), and postoperative red blood cell (RBC) transfusion (1.603 (1.193-2.152), = 0.002) as risk factors for postoperative complications after PLIF surgery.
CSA, ASA PS III, and postoperative RBC transfusion might be used as predictors of postoperative complications after PLIF in patients aged >65 years.
目前缺乏关于利用术前腰椎计算机断层扫描或磁共振成像评估骨骼肌质量，以此作为老年患者后路腰椎椎间融合术（PLIF）术后并发症预测指标的研究。
纳入年龄>65岁且接受PLIF手术的患者。竖脊肌横截面积总和（CSA）作为骨骼肌质量指标。通过CSA、肺功能测试和预后营养指数（PNI）评估术后并发症。
术后出现并发症的患者，其CSA值（中位数2266.70（2239.73 - 2875.10）mm² vs. 3060.30（2749.25 - 3473.30）mm²，P < 0.001）、功能肺活量、第1秒用力呼气量和PNI均显著降低。然而，多因素logistic回归分析确定美国麻醉医师协会身体状况分级（ASA PS）I级（比值比0.307（95%置信区间0.110 - 0.852），P = 0.023）、ASA PS III级（4.033（1.586 - 10.254），P = 0.003）、CSA（0.999（0.999 - 1.000），P < 0.001）以及术后红细胞（RBC）输血（1.603（1.193 - 2.152），P = 0.002）为PLIF术后并发症的危险因素。
CSA、ASA PS III级和术后RBC输血可作为>65岁患者PLIF术后并发症的预测指标。
