Carbone Jake, Ratanpal Amit, Chiu Anthony K, Suresh Rohan I, Anderson Bradley, Amatya Bibhas, Sahai Amil, Shear Brian, Ruditsky Alexander, Ghenbot Sennay, Bivona Louis J, Jauregui Julio J, Cavanaugh Daniel L, Koh Eugene Y, Ludwig Steven C
Division of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center, 110 South Paca Street, Suite 300, Baltimore, MD, 21201, USA.
Eur Spine J. 2025 Feb;34(2):782-787. doi: 10.1007/s00586-024-08616-9. Epub 2024 Dec 23.
Three-column osteotomies (3COs), such as pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), are used to surgically correct rigid adult spinal deformity (ASD). While extensive research exists about complications associated with 3COs, there remains a paucity of studies analyzing risk factors for mortality following 3CO. We believe the mortality rate after 3-column osteotomy will be low with specific identifiable demographic or medical risk factors.
A retrospective analysis was conducted using the National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing 3CO were identified via CPT codes. The primary outcome of interest was 30-day postoperative mortality. Univariate statistical analysis was performed, followed by multivariable logistic regression controlling for age, sex, and body mass index (BMI).
The analysis included 1,441 patients. 446 patients had thoracic osteotomies, 996 patients had lumbar osteotomies, and 226 had multilevel osteotomies. The overall 30-day mortality rate was 1.2% (18 patients). On univariate analysis, mortality was more likely in patients with diabetes (2.8% vs. 1.2%, P = 0.029) and COPD (7.0% vs. 1.2%, P < 0.001). Mortality was associated with higher 5-factor modified frailty index (P = 0.004). After controlling for age, sex, and BMI, multivariable analysis revealed that mortality rates were independently associated with longer operative times (OR = 1.28, 95% CI:1.06-1.54, P = 0.010) and COPD (OR = 10.36, 95% CI: [2.17-49.47], P = 0.003).
Thirty-day mortality after 3CO is 1.2% globally. The greatest univariate risk factors are diabetes, COPD, and frailty. Regardless of age, sex, or BMI, it was found that COPD and duration of surgery were independently associated with increased rates of mortality.
三柱截骨术（3COs），如椎弓根截骨术（PSO）和脊柱切除术（VCR），用于手术矫正成人僵硬性脊柱畸形（ASD）。虽然关于3COs相关并发症已有大量研究，但分析3CO后死亡风险因素的研究仍然匮乏。我们认为，在存在特定可识别的人口统计学或医学风险因素的情况下，三柱截骨术后的死亡率会很低。
使用国家外科质量改进计划（NSQIP）数据库进行回顾性分析。通过CPT编码识别接受3CO的患者。主要关注的结局是术后30天死亡率。进行单变量统计分析，然后进行多变量逻辑回归分析，并对年龄、性别和体重指数（BMI）进行控制。
分析纳入了1441例患者。446例患者进行了胸椎截骨术，996例患者进行了腰椎截骨术，226例患者进行了多节段截骨术。总体30天死亡率为1.2%（18例患者）。单变量分析显示，糖尿病患者（2.8%对1.2%，P = 0.029）和慢性阻塞性肺疾病（COPD）患者（7.0%对1.2%，P < 0.001）的死亡率更高。死亡率与较高的五因素改良衰弱指数相关（P = 0.004）。在对年龄、性别和BMI进行控制后，多变量分析显示，死亡率与手术时间延长（OR = 1.28，95%CI：1.06 - 1.54，P = 0.010）和COPD（OR = 10.36，95%CI：[2.17 - 49.47]，P = 0.003）独立相关。
全球范围内，3CO术后30天死亡率为1.2%。最大的单变量风险因素是糖尿病、COPD和衰弱。无论年龄、性别或BMI如何，发现COPD和手术持续时间与死亡率增加独立相关。
