Zhang Haoran, Zhao Yiwei, Du You, Yang Yang, Zhang Jianguo, Wang Shengru
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):21. doi: 10.1007/s00402-024-05646-2.
The purpose of this study was to explore the optimal timing and associated risks of spinal deformity surgery during the COVID‑19 pandemic.
All consecutive surgical cases for spinal deformity between November 2022 and April 2023 were included. The population was divided into several categories according to the time from diagnosis of SARS-CoV-2 infection to the day of surgery: without infection (pre-COVID-19), infection at 0 to 4 weeks (peri-COVID-19), infection at 4 to 8 weeks (early post-COVID-19), and infection over 8 weeks (late post-COVID-19). The primary outcome and secondary outcomes were 90-day complication rate and total hospital stay. Postoperative complications and total hospital stay were analyzed using logistic regression and linear regression models, and we simultaneously showed the results from the crude model, minimally adjusted model and fully adjusted model. In addition, we performed various sensitivity analyses.
A total of 60 consecutive patients were enrolled. The overall complication rate at 90 days postoperatively was 41.6% (25 of 60 patients), and the total hospital stay for all patients was (10.1 ± 3.5) days. In the fully adjusted model, compared with pre-COVID-19 patients, peri-COVID-19 patients had a 5.1-fold increased risk of postoperative complications (OR = 6.1, 95% CI 1.1-31.9, P = 0.030), early post-COVID-19 patients and late post-COVID-19 patients were at essentially equal risk. In terms of total hospital stay, compared with patients not infected with SARS-CoV-2, peri-COVID-19 patients had a 3.1-day longer hospital stay (ꞵ = 3.1, 95%CI 0.3-5.8, P = 0.032), early post-COVID-19 patients also had a 3.1-day longer hospital stay (ꞵ = 3.1, 95%CI 0.3-6.0, P = 0.032), and late post-COVID-19 patients had the similar hospital stay (ꞵ = -0.4, 95%CI -2.9-2.1, P = 0.741). Sensitivity analysis showed that the conclusions were robust.
With careful preoperative screening of patients for COVID-19, spinal deformity surgery can proceed safely during the epidemic. We recommend that spinal deformity surgery be delayed in patients with COVID-19 until 8 weeks after SARS-CoV-2 infection.
本研究旨在探讨在新冠疫情期间脊柱畸形手术的最佳时机及相关风险。
纳入2022年11月至2023年4月期间所有连续性脊柱畸形手术病例。根据从确诊感染SARS-CoV-2到手术日期的时间将人群分为几类：未感染（新冠疫情前）、感染后0至4周（新冠疫情期间）、感染后4至8周（新冠疫情早期）、感染超过8周（新冠疫情后期）。主要结局和次要结局分别为90天并发症发生率和总住院时间。采用逻辑回归和线性回归模型分析术后并发症和总住院时间，并同时展示粗模型、最小调整模型和完全调整模型的结果。此外，我们还进行了各种敏感性分析。
共纳入60例连续患者。术后90天的总体并发症发生率为41.6%（60例患者中的25例），所有患者的总住院时间为（10.1±3.5）天。在完全调整模型中，与新冠疫情前患者相比，新冠疫情期间患者术后并发症风险增加5.1倍（OR = 6.1，95%CI 1.1 - 31.9，P = 0.030），新冠疫情早期患者和新冠疫情后期患者的风险基本相等。在总住院时间方面，与未感染SARS-CoV-2的患者相比，新冠疫情期间患者的住院时间延长3.1天（β = 3.1，95%CI 0.3 - 5.8，P = 0.032），新冠疫情早期患者的住院时间也延长3.1天（β = 3.1，95%CI 0.3 - 6.0，P = 0.032），而新冠疫情后期患者的住院时间相似（β = -0.4，95%CI -2.9 - 2.1，P = 0.741）。敏感性分析表明结论可靠。
通过对患者进行仔细的术前新冠筛查，脊柱畸形手术在疫情期间可以安全进行。我们建议新冠患者的脊柱畸形手术推迟到感染SARS-CoV-2后8周进行。
