Gallagher Ryan S, Karsalia Ritesh, Xu Emily, Wathen Connor A, Borja Austin J, Na Jianbo, Collier Tara, McClintock Scott, Malhotra Neil R
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, PA, USA.
Global Spine J. 2024 Dec 5:21925682241307631. doi: 10.1177/21925682241307631.
Retrospective Matched Cohort Study.
Optimization of medical comorbidities is an essential part of preoperative management. However, the isolated effects of individual comorbidities have not been evaluated within a homogenous spine surgery population. This exact matching study aims to assess the independent effects of cancer on outcomes following single-level lumbar fusions for non-cancer surgery.
4680 consecutive patients undergoing single-level posterior-only lumbar fusion were retrospectively enrolled. Univariate statistics and coarsened exact matching (CEM) were computed to evaluate outcomes between cancer patients and those without comorbidities.
By logistic regression, malignancy conferred a higher risk of surgical complication ( = 0.016, OR = 2.64, CI = [1.200,5.790]), 30- and 90- day readmission ( = 0.012, OR = 2.025, CI = [1.170-3.510]; < 0.001, OR = 2.34, CI = [1.430, 3.830], respectively), 90-day reoperation ( < 0.001, OR = 2.16, [1.110, 4.200]), and death at 90-days ( = 0.032, OR = 8.27, CI = [1.200, 56.850]). After matching, malignancy was associated with increased odds of incidental durotomy (6 vs 0 cases, = 0.048) and death at both 30 and 90 days (both: OR = 8.0, = 0.020, CI = [1.00, 63.960]). No cases of durotomy occurred in cases with mortality in the matched sample, suggesting independent relationships. There were no differences in length of stay, non-home discharge, ED evaluation, readmission, or reoperations.
Among otherwise exact-matched patients undergoing single level lumbar fusion, history of malignancy conferred a higher risk of short-term mortality, but not other outcomes suggestive of surgical failure. Increased mortality after lumbar fusion should be studied further and may play a role in surgical decision-making and patient discussions.
回顾性匹配队列研究。
优化合并症是术前管理的重要组成部分。然而，在同质化的脊柱手术人群中，尚未评估个体合并症的单独影响。这项精确匹配研究旨在评估癌症对非癌症手术单节段腰椎融合术后结局的独立影响。
回顾性纳入4680例连续接受单节段后路腰椎融合术的患者。计算单因素统计量和粗化精确匹配（CEM），以评估癌症患者与无合并症患者之间的结局。
通过逻辑回归分析，恶性肿瘤导致手术并发症风险更高（P = 0.016，OR = 2.64，CI = [1.200, 5.790]）、30天和90天再入院风险更高（P = 0.012，OR = 2.025，CI = [1.170 - 3.510]；P < 0.001，OR = 2.34，CI = [1.430, 3.830]）、90天再次手术风险更高（P < 0.001，OR = 2.16，[1.110, 4.200]）以及90天死亡风险更高（P = 0.032，OR = 8.27，CI = [1.200, 56.850]）。匹配后，恶性肿瘤与意外硬脊膜切开术几率增加（6例对0例，P = 0.048）以及30天和90天死亡几率增加相关（两者：OR = 8.0，P = 0.020，CI = [1.00, 63.960]）。在匹配样本中，死亡病例未发生硬脊膜切开术，提示存在独立关系。住院时间、非回家出院、急诊评估、再入院或再次手术方面无差异。
在其他方面精确匹配的接受单节段腰椎融合术的患者中，恶性肿瘤病史导致短期死亡风险更高，但不导致其他提示手术失败的结局风险增加。腰椎融合术后死亡率增加应进一步研究，可能在手术决策和患者讨论中发挥作用。
