Chan Justin P, Hoang Henry, Hashmi Sohaib Z, Lee Yu-Po, Bhatia Nitin N
Department of Orthopaedic Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, United States.
N Am Spine Soc J. 2023 Aug 11;16:100262. doi: 10.1016/j.xnsj.2023.100262. eCollection 2023 Dec.
COVID-19 has been shown to adversely affect multiple organ systems, yet little is known about its effect on perioperative complications after spine surgery or the optimal timing of surgery after an infection. We used the NIH National COVID Cohort Collaborative (N3C) database to characterize the risk profile in patients undergoing spine surgery during multiple time windows following COVID-19 infection.
We queried the National COVID Cohort Collaborative, a database of 17.4 million persons with 6.9 million COVID-19 cases, for patients undergoing lumbar spinal fusion surgery. Patients were stratified into those with an initial documented COVID-19 infection within 3 time periods: 0 to 2 weeks, 2 to 6 weeks, or 6 to 12 weeks before surgery.
A total of 60,541 patients who underwent lumbar spinal fusion procedures were included. Patients who underwent surgery within 2 weeks of their COVID-19 diagnosis had a significantly increased risk for venous thromboembolic events (OR 2.29, 95% CI 1.58-3.32), sepsis (OR 1.56, 95% CI 1.03-2.36), 30-day mortality (OR 5.55, 95% CI 3.53-8.71), and 1-year mortality (OR 2.70, 95% CI 1.91-3.82) compared with patients who were COVID negative during the same period. There was no significant difference in the rates of acute kidney injury or surgical site infection. Patients undergoing surgery between 2 and 6 weeks or between 6 and 12 weeks from the date of COVID-19 infection did not show significantly elevated rates of any complication analyzed.
Patients undergoing lumbar spinal fusion within 2 weeks from initial COVID-19 diagnosis are at increased risk for perioperative venous thromboembolic events and sepsis. This effect does not persist beyond 2 weeks, however, so it may be warranted to postpone non-urgent spine surgeries for at least 2 weeks following a COVID-19 infection or to consider a more aggressive VTE chemoprophylaxis regimen for urgent surgery in COVID-19 patients.
已有研究表明，新型冠状病毒肺炎（COVID-19）会对多个器官系统产生不利影响，但对于其对脊柱手术后围手术期并发症的影响，或感染后手术的最佳时机，人们知之甚少。我们利用美国国立卫生研究院国家COVID队列协作研究（N3C）数据库，对COVID-19感染后多个时间窗内行脊柱手术患者的风险特征进行了描述。
我们在拥有1740万人及690万例COVID-19病例的国家COVID队列协作研究数据库中，查询接受腰椎融合手术的患者。患者被分为3个时间段内首次有记录的COVID-19感染患者：手术前0至2周、2至6周或6至12周。
共纳入60541例接受腰椎融合手术的患者。与同期COVID阴性患者相比，在COVID-19诊断后2周内接受手术的患者发生静脉血栓栓塞事件（比值比[OR]2.29，95%置信区间[CI]1.58 - 3.32）、脓毒症（OR 1.56，95% CI 1.03 - 2.36）、30天死亡率（OR 5.55，95% CI 3.53 - 8.71）及1年死亡率（OR 2.70，95% CI 1.91 - 3.82）的风险显著增加。急性肾损伤或手术部位感染发生率无显著差异。在COVID-19感染日期后2至6周或6至12周接受手术的患者，所分析的任何并发症发生率均未显著升高。
初次COVID-19诊断后2周内行腰椎融合手术的患者，围手术期静脉血栓栓塞事件和脓毒症风险增加。然而，这种影响不会持续超过2周，因此对于非紧急脊柱手术，可能有必要在COVID-19感染后至少推迟2周进行，或者对于COVID-19患者的紧急手术，考虑采用更积极的静脉血栓栓塞化学预防方案。
