Illescas Alex, Poeran Jashvant, Zhong Haoyan, Cozowicz Crispiana, Girardi Federico P, Memtsoudis Stavros G, Liu Jiabin
Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA.
Institute for Healthcare Delivery Science, Departments of Population Health Science and Policy and Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
HSS J. 2024 Nov;20(4):464-469. doi: 10.1177/15563316241253604. Epub 2024 May 21.
Although the coexistence of cervical and lumbar spinal conditions is fairly common, surgical treatments are usually staged, even though simultaneous fusion of the cervical and lumbar spine may be a viable option for appropriate candidates. We sought to investigate the outcomes of staged vs simultaneous cervical and lumbar fusions in terms of differences in postoperative complications and resource use. We performed a retrospective cohort study using claims data from the 2006 to 2020 all-payer Premier Health Database. Data were extracted for patients who underwent both a cervical and a lumbar fusion procedure either simultaneously (same hospitalization) or staged (within 1 year). Multivariable regression models measured the association between simultaneous or staged procedures and combined complications (including venous thromboembolism, infection, acute renal failure, or vascular/pulmonary/gastrointestinal complications), intensive care unit (ICU) admission, and prolonged length of stay. We report odds ratios (ORs) and 95% confidence intervals (CI). Overall, 560 (5.2%) and 10 187 (94.8%) of total 10 747 cervical and lumbar fusion procedures were performed simultaneously and staged, respectively. When comparing outcomes after simultaneous procedures to those after staged procedures (for which outcomes from the cervical and lumbar procedures were pooled), simultaneous procedures were associated with higher rates of ICU admission and longer hospital stays, but there were no differences in rates of combined complications. Our retrospective, nationwide database study found that simultaneous cervical and lumbar fusion is relatively rare and its rates of complications do not differ meaningfully from those of staged procedures. However, we found an association between simultaneous cervical and lumbar fusion and higher rates of ICU admission and prolonged length of stay. Further study is warranted.
虽然颈椎和腰椎疾病并存相当常见，但手术治疗通常是分阶段进行的，尽管对于合适的患者来说，颈椎和腰椎同时融合可能是一种可行的选择。我们试图研究分阶段与同时进行颈椎和腰椎融合在术后并发症和资源使用差异方面的结果。我们使用2006年至2020年全支付方Premier健康数据库中的理赔数据进行了一项回顾性队列研究。提取了同时（同一住院期间）或分阶段（1年内）接受颈椎和腰椎融合手术的患者的数据。多变量回归模型测量了同时或分阶段手术与合并并发症（包括静脉血栓栓塞、感染、急性肾衰竭或血管/肺/胃肠道并发症）、重症监护病房（ICU）入院和住院时间延长之间的关联。我们报告优势比（OR）和95%置信区间（CI）。总体而言，在总共10747例颈椎和腰椎融合手术中，分别有560例（5.2%）和10187例（94.8%）是同时进行和分阶段进行的。将同时手术的结果与分阶段手术的结果（将颈椎和腰椎手术的结果合并）进行比较时，同时手术与ICU入院率较高和住院时间较长相关，但合并并发症的发生率没有差异。我们的回顾性全国数据库研究发现，颈椎和腰椎同时融合相对少见，其并发症发生率与分阶段手术相比没有显著差异。然而，我们发现颈椎和腰椎同时融合与ICU入院率较高和住院时间延长之间存在关联。有必要进行进一步研究。
