Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Clin Spine Surg. 2024 Oct 1;37(8):E348-E353. doi: 10.1097/BSD.0000000000001599. Epub 2024 Mar 14.
Retrospective review.
To determine whether the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" score is associated with the development of postoperative ileus.
Adult spinal deformity (ASD) surgery has a high complication rate. One common complication is postoperative ileus, and poor postoperative mobility has been implicated as a modifiable risk factor for this condition.
Eighty-five ASD surgeries in which ≥5 levels were fused were identified in a single institution database. A physical therapist/physiatrist collected patients' daily postoperative AM-PAC scores, for which we assessed first, last, and daily changes. We used multivariable linear regression to determine the marginal effect of ileus on continuous AM-PAC scores; threshold linear regression with Bayesian information criterion to identify a threshold AM-PAC score associated with ileus; and multivariable logistic regression to determine the utility of the score thresholds when controlling for confounding variables.
Ten of 85 patients (12%) developed ileus. The mean day of developing ileus was postoperative day 3.3±2.35. The mean first and last AM-PAC scores were 16 and 18, respectively. On bivariate analysis, the mean first AM-PAC score was lower in patients with ileus than in those without (13 vs. 16; P< 0.01). Ileus was associated with a first AM-PAC score of 3 points lower (Coef. -2.96; P< 0.01) than that of patients without ileus. Patients with an AM-PAC score<13 had 8 times greater odds of developing ileus ( P= 0.023). Neither the last AM-PAC score nor the daily change in AM-PAC score was associated with ileus.
In our institutional cohort, a first AM-PAC score of <13, corresponding to an inability to walk or stand for more than 1 minute, was associated with the development of ileus. Early identification of patients who cannot walk or stand after surgery can help determine which patients would benefit from prophylactic management.
Level-III.
回顾性研究。
确定术后肠梗阻与活动后康复评估（AM-PAC）“6 点击”评分之间是否存在关联。
成人脊柱畸形（ASD）手术的并发症发生率较高。一种常见的并发症是术后肠梗阻，而术后活动能力差被认为是这种情况的一个可改变的危险因素。
在一个单一机构的数据库中确定了 85 例融合≥5 个节段的 ASD 手术。一名物理治疗师/物理医学家收集了患者的每日术后 AM-PAC 评分，我们评估了首次、末次和每日的变化。我们使用多元线性回归来确定肠梗阻对连续 AM-PAC 评分的边际效应；使用具有贝叶斯信息准则的门限线性回归来识别与肠梗阻相关的 AM-PAC 评分门限；并使用多变量逻辑回归来确定在控制混杂变量的情况下评分门限的效用。
85 例患者中有 10 例（12%）发生了肠梗阻。发生肠梗阻的平均时间为术后第 3.3±2.35 天。首次和末次 AM-PAC 评分的平均值分别为 16 和 18。在单变量分析中，发生肠梗阻的患者的首次 AM-PAC 评分低于未发生肠梗阻的患者（13 与 16；P<0.01）。与未发生肠梗阻的患者相比，发生肠梗阻的患者首次 AM-PAC 评分低 3 分（Coef. -2.96；P<0.01）。AM-PAC 评分<13 的患者发生肠梗阻的几率增加 8 倍（P=0.023）。末次 AM-PAC 评分或 AM-PAC 评分的每日变化均与肠梗阻无关。
在我们的机构队列中，首次 AM-PAC 评分<13，对应于无法行走或站立超过 1 分钟，与肠梗阻的发生相关。早期识别手术后无法行走或站立的患者，可以帮助确定哪些患者将受益于预防性治疗。
III 级。
