Doi Kazuma, Otani Naoki, Inoue Norihiko, Mizuno Junichi, Fushimi Kiyohide, Yoshino Atsuo
Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
Center for Minimally Invasive Spinal Surgery, Shin-Yurigaoka General Hospital, Kawasaki, Japan.
Asian Spine J. 2024 Aug;18(4):508-513. doi: 10.31616/asj.2023.0448. Epub 2024 Aug 9.
Retrospective study of data abstracted from the Diagnosis Procedure Combination (DPC) database.
This study aimed to investigate the effects of surgery in the early phase.
The optimal timing of surgery for cervical fracture dislocation (CFD) remains unclear because only a few clinical studies with approximately 100 patients have been published.
This study included 4,653 adult patients with a definitive diagnosis of CFD from the DPC database. The database contains nationwide inpatient data collected from >1,000 acute care hospitals in Japan. The DPC database contains information regarding hospitalization, such as diagnosis, treatment, medical history, complications, and hospitalization outcomes. This study identified 460 pairs of patients after one-to-one propensity-score matching (PSM). Treatment outcomes were compared between patients who underwent surgery for CFD within 72 hours (early group) and later (delayed group) after admission. The main outcomes included 30-day mortality, inhospital death, and major complications. The secondary outcomes were improvement in the Barthel index, length of hospital stay, and discharged home rate.
After adjusting for PSM, the early group had a significantly higher 30-day mortality rates than the delayed group (3.0% vs. 0.4%, p=0.006). In the multivariate logistic regression analysis after PSM, the early group was associated with an increased risk of 30-day mortality (odds ratio, 8.05; 95% confidence interval, 2.15-5.26; p=0.007).
This study indicated that early surgery for CFD resulted in increased 30-day mortality.
对从诊断程序组合（DPC）数据库中提取的数据进行回顾性研究。
本研究旨在调查早期手术的效果。
颈椎骨折脱位（CFD）手术的最佳时机仍不明确，因为仅有少数涉及约100例患者的临床研究发表。
本研究纳入了DPC数据库中4653例确诊为CFD的成年患者。该数据库包含从日本1000多家急性护理医院收集的全国住院患者数据。DPC数据库包含有关住院的信息，如诊断、治疗、病史、并发症和住院结局。本研究在一对一倾向评分匹配（PSM）后确定了460对患者。比较了入院后72小时内接受CFD手术的患者（早期组）和之后（延迟组）的治疗结局。主要结局包括30天死亡率、住院死亡和主要并发症。次要结局为Barthel指数改善情况、住院时间和出院回家率。
在对PSM进行调整后，早期组的30天死亡率显著高于延迟组（3.0%对0.4%，p = 0.006）。在PSM后的多因素逻辑回归分析中，早期组与30天死亡风险增加相关（比值比，8.05；95%置信区间，2.15 - 5.26；p = 0.007）。
本研究表明，CFD早期手术导致30天死亡率增加。
