成人脊柱畸形手术中的术中液体管理：差异分析及其与预后的关联
Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes.
作者信息
Cetik Riza M, Gum Jeffrey L, Lafage Renaud, Smith Justin S, Bess Shay, Mullin Jeffrey P, Kelly Michael P, Diebo Bassel G, Buell Thomas J, Scheer Justin K, Line Breton G, Lafage Virginie, Klineberg Eric O, Kim Han Jo, Passias Peter G, Kebaish Khaled M, Eastlack Robert K, Daniels Alan H, Soroceanu Alex, Mundis Gregory M, Hostin Richard A, Protopsaltis Themistocles S, Hamilton D Kojo, Hart Robert A, Gupta Munish C, Lewis Stephen J, Schwab Frank J, Lenke Lawrence G, Shaffrey Christopher I, Ames Christopher P, Burton Douglas C
机构信息
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, USA.
Northwell, Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, USA.
出版信息
Spine Deform. 2025 Jan;13(1):241-250. doi: 10.1007/s43390-024-00966-0. Epub 2024 Sep 12.
PURPOSE
To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS).
METHODS
Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV) fluid data were collected including: crystalloids, colloids, crystalloid/colloid ratio (C/C), total IV fluid (tIVF, ml), normalized total IV fluid (nIVF, ml/kg/h), input/output ratio (IOR), input-output difference (IOD), and normalized input-output difference (nIOD, ml/kg/h). Data from different centers were compared for variability analysis, and fluid parameters were analyzed for possible associations with the outcomes.
RESULTS
Seven hundred ninety-eight patients with a median age of 65.2 were included. Among different surgical centers, tIVF, nIVF, and C/C showed significant variation (p < 0.001 for each) with differences of 4.8-fold, 3.7-fold, and 4.9-fold, respectively. Two hundred ninety-two (36.6%) patients experienced at least one in-hospital complication, and ninety-two (11.5%) were IV fluid related. Univariate analysis showed significant relations for: LOS and tIVF (ρ = 0.221, p < 0.001), IOD (ρ = 0.115, p = 0.001) and IOR (ρ = -0.138, p < 0.001); IV fluid-related complications and tIVF (p = 0.049); ICU stay and tIVF, nIVF, IOD and nIOD (p < 0.001 each); extended ICU stay and tIVF (p < 0.001), nIVF (p = 0.010) and IOD (p < 0.001). Multivariate analysis controlling for confounders showed significant relations for: LOS and tIVF (p < 0.001) and nIVF (p = 0.003); ICU stay and IOR (p = 0.002), extended ICU stay and tIVF (p = 0.004).
CONCLUSION
Significant variability and lack of standardization in intraoperative IV fluid management exists between different surgical centers. Excessive fluid administration was found to be correlated with negative outcomes.
LEVEL OF EVIDENCE
III.
目的
评估成人脊柱畸形（ASD）手术中液体管理的变异性，并分析其与并发症、重症监护病房（ICU）需求及住院时间（LOS）的相关性。
方法
多中心比较队列研究。纳入年龄≥18岁且患有ASD的患者。收集术中静脉输液数据，包括：晶体液、胶体液、晶体液/胶体液比例（C/C）、总静脉输液量（tIVF，ml）、标准化总静脉输液量（nIVF，ml/kg/h）、输入/输出比（IOR）、输入-输出差值（IOD）及标准化输入-输出差值（nIOD，ml/kg/h）。比较不同中心的数据以进行变异性分析，并分析液体参数与结局之间可能的相关性。
结果
纳入798例患者，中位年龄为65.2岁。在不同手术中心之间，tIVF、nIVF和C/C显示出显著差异（各p<0.001），差异分别为4.8倍、3.7倍和4.9倍。292例（36.6%）患者至少发生1例院内并发症，92例（11.5%）与静脉输液相关。单因素分析显示，LOS与tIVF（ρ=0.221，p<0.001）、IOD（ρ=0.115，p=0.001）和IOR（ρ=-0.138，p<0.001）之间存在显著相关性；静脉输液相关并发症与tIVF（p=0.049）之间存在显著相关性；ICU住院时间与tIVF、nIVF、IOD和nIOD（各p<0.001）之间存在显著相关性；延长的ICU住院时间与tIVF（p<0.001）、nIVF（p=0.010）和IOD（p<0.001）之间存在显著相关性。控制混杂因素的多因素分析显示，LOS与tIVF（p<0.001）和nIVF（p=0.003）之间存在显著相关性；ICU住院时间与IOR（p=0.002）之间存在显著相关性；延长的ICU住院时间与tIVF（p=0.004）之间存在显著相关性。
结论
不同手术中心在术中静脉输液管理方面存在显著变异性且缺乏标准化。发现过量输液与不良结局相关。
证据级别
III级。
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