COVID-19 症状对小儿脊柱畸形手术时机与术后并发症关联的修饰作用：一项前瞻性队列研究。

Effect Modification of COVID-19 Symptoms on the Association Between Timing of Surgery and Postoperative Complications in Pediatric Spinal Deformity: A Prospective Cohort Study.

机构信息

Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

出版信息

World Neurosurg. 2024 Apr;184:e76-e83. doi: 10.1016/j.wneu.2024.01.053. Epub 2024 Jan 13.

DOI:10.1016/j.wneu.2024.01.053

PMID:38224906

Abstract

OBJECTIVE

The purpose of this study was to explore the optimal timing and associated risks of pediatric spinal deformity surgery during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

All consecutive surgical cases for spinal deformity between September 2022 and May 2023 were included. The population was divided into several categories according to the time from diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to the day of surgery. Postoperative complications were analyzed using logistic regression, and we simultaneously showed the results from the crude model, minimally adjusted model, and fully adjusted model.

RESULTS

A total of 81 consecutive patients were enrolled. In the fully adjusted model, compared with pre-COVID-19 patients, peri-COVID-19 patients had a 4.5-fold increased risk of postoperative complications (odds ratio = 5.5, 95% confidence interval 1.1-27.2, P = 0.037), early post-COVID-19 patients had a 2.3-fold increased risk (odds ratio= 3.3, 95% confidence interval 0.7-16.1, P = 0.133), and late post-COVID-19 patients were at essentially equal risk. In asymptomatic population, early post-COVID-19 patients and late post-COVID-19 patients appeared to be at equal risk compared with pre-COVID-19 patients. For patients with persistent symptoms, is necessary to wait at least 8 weeks or even longer after SARS-CoV-2 infection. Interaction tests demonstrated that the effect of the timing of surgery on postoperative complications significantly differed in populations with different symptoms.

CONCLUSIONS

Surgery for pediatric spinal deformity should be postponed until 8 weeks after SARS-CoV-2 infection in cases with COVID-19-related symptoms within 2 weeks prior to surgery; whereas, for those who are asymptomatic within 2 weeks prior to surgery, an interval of 4 weeks seemed to be sufficient.

摘要

目的

本研究旨在探讨在 2019 年冠状病毒病（COVID-19）大流行期间，小儿脊柱畸形手术的最佳时机和相关风险。

方法

纳入 2022 年 9 月至 2023 年 5 月期间连续进行的脊柱畸形手术病例。根据从严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染诊断到手术日的时间，将人群分为几类。使用逻辑回归分析术后并发症，并同时展示粗模型、最小调整模型和完全调整模型的结果。

结果

共纳入 81 例连续患者。在完全调整模型中，与 COVID-19 前患者相比，COVID-19 期间患者术后并发症的风险增加了 4.5 倍（比值比=5.5，95%置信区间 1.1-27.2，P=0.037），COVID-19 早期患者的风险增加了 2.3 倍（比值比=3.3，95%置信区间 0.7-16.1，P=0.133），而 COVID-19 晚期患者的风险基本相同。在无症状人群中，COVID-19 早期和晚期患者与 COVID-19 前患者的风险似乎相等。对于持续性症状的患者，有必要在 SARS-CoV-2 感染后至少等待 8 周甚至更长时间。交互检验表明，手术时机对术后并发症的影响在有症状和无症状人群中显著不同。