Department of Orthopedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
BMC Musculoskelet Disord. 2024 Jul 3;25(1):513. doi: 10.1186/s12891-024-07617-5.
BACKGROUND: Although posterior decompression with fusion (PDF) are effective for treating thoracic myelopathy, surgical treatment has a high risk of various complications. There is currently no information available on the perioperative complications in thoracic ossification of the longitudinal ligament (T-OPLL) and thoracic ossification of the ligamentum flavum (T-OLF). We evaluate the perioperative complication rate and cost between T-OPLL and T-OLF for patients underwent PDF. METHODS: Patients undergoing PDF for T-OPLL and T-OLF from 2012 to 2018 were detected in Japanese nationwide inpatient database. One-to-one propensity score matching between T-OPLL and T-OLF was performed based on patient characteristics and preoperative comorbidities. We examined systemic and local complication rate, reoperation rate, length of hospital stays, costs, discharge destination, and mortality after matching. RESULTS: In a total of 2,660 patients, 828 pairs of T-OPLL and T-OLF patients were included after matching. The incidence of systemic complications did not differ significantly between the T-OPLL and OLF groups. However, local complications were more frequently occurred in T-OPLL than in T-OLF groups (11.4% vs. 7.7% P = 0.012). Transfusion rates was also significantly higher in the T-OPLL group (14.1% vs. 9.4%, P = 0.003). T-OPLL group had longer hospital stay (42.2 days vs. 36.2 days, P = 0.004) and higher medical costs (USD 32,805 vs. USD 25,134, P < 0.001). In both T-OPLL and T-OLF, the occurrence of perioperative complications led to longer hospital stay and higher medical costs. While fewer patients in T-OPLL were discharged home (51.6% vs. 65.1%, P < 0.001), patients were transferred to other hospitals more frequently (47.5% vs. 33.5%, P = 0.001). CONCLUSION: This research identified the perioperative complications of T-OPLL and T-OLF in PDF using a large national database, which revealed that the incidence of local complications was higher in the T-OPLL patients. Perioperative complications resulted in longer hospital stays and higher medical costs.
背景：尽管后路减压融合术（PDF）治疗胸段脊髓病有效，但手术治疗存在多种并发症的高风险。目前尚无关于胸段后纵韧带骨化（T-OPLL）和胸段黄韧带骨化（T-OLF）患者围手术期并发症的信息。我们评估了接受 PDF 治疗的 T-OPLL 和 T-OLF 患者的围手术期并发症发生率和成本。 方法：从 2012 年至 2018 年，在日本全国住院患者数据库中检测到接受 PDF 治疗的 T-OPLL 和 T-OLF 患者。根据患者特征和术前合并症，对 T-OPLL 和 T-OLF 进行一对一倾向评分匹配。我们检查了系统和局部并发症发生率、再次手术率、住院时间、成本、出院去向和匹配后的死亡率。 结果：在总共 2660 名患者中，匹配后纳入了 828 对 T-OPLL 和 T-OLF 患者。T-OPLL 组和 OLF 组的全身并发症发生率无显著差异。然而，T-OPLL 组局部并发症的发生率高于 T-OLF 组（11.4%比 7.7%，P=0.012）。T-OPLL 组的输血率也明显更高（14.1%比 9.4%，P=0.003）。T-OPLL 组的住院时间更长（42.2 天比 36.2 天，P=0.004），医疗费用更高（32805 美元比 25134 美元，P<0.001）。在 T-OPLL 和 T-OLF 中，围手术期并发症的发生导致住院时间延长和医疗费用增加。虽然 T-OPLL 组出院回家的患者较少（51.6%比 65.1%，P<0.001），但更多的患者被转移到其他医院（47.5%比 33.5%，P=0.001）。 结论：本研究使用大型国家数据库确定了 PDF 治疗中 T-OPLL 和 T-OLF 的围手术期并发症，结果显示 T-OPLL 患者局部并发症的发生率更高。围手术期并发症导致住院时间延长和医疗费用增加。
Medicine (Baltimore). 2022-2-25
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