Cui Peng, Han Di, Chen Xiao-Long, Wang Peng, Lu Shi-Bao
Department of Orthopedics & Elderly Spinal Surgery, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China.
BMC Surg. 2024 Dec 27;24(1):422. doi: 10.1186/s12893-024-02726-3.
To specifically evaluate the safety and benefit of different drainage removal criteria (50 ml and 100 ml per 24 h) in patients undergoing short-level lumbar fusion surgery.
Patients with degenerative lumbar diseases who underwent short level lumbar fusion with instrumentation between January 2021 and January 2023 were retrospectively recruited in the study. Based on the different criteria for drainage removal, the patients were divided into 2 groups (group A and group B). To control for confounding factors, a 1:1 nearest propensity score matching of significant variation, especially age, gender, BMI, number of fused levels, intraoperative blood loss, and surgical duration, were performed between groups. Perioperative outcomes were compared between groups. Multivariate logistic regression was performed to determine the risk factors for overall complications.
A total of 1004 eligible patients were reviewed in this study with 676 patients in group A and 328 patients in group B. After propensity score matching, 616 patients, 308 in each group were included in the final analysis. There were significantly more patients getting drainage removed on POD 2 (23.1% vs. 32.1%, p = 0.012) and POD 3 (37.0% vs., 45.1%, p = 0.041) in group B. In addition, patients in group B had earlier postoperative timing of ambulation (3.87 ± 1.12 vs. 2.41 ± 1.34, p = 0.012). No significant difference in symptomatic hematoma and surgical site infection was observed, but there were significant fewer overall complications (10.39% vs. 5.19%, p = 0.016) in the group B. Multivariate logistic regression indicated that postoperative timing of ambulation (OR 2.38, 95% CI 1.19-3.97, p < 0.001) was independently associated with overall complications.
In this study, we found that the relaxation of the criteria for drainage removal could significantly shorten the length of stay, in addition, it could promote early postoperative ambulation of patients and thus reduce the occurrence of perioperative overall complications.
具体评估短节段腰椎融合手术患者不同引流量拔除标准（每24小时50毫升和100毫升）的安全性和益处。
回顾性纳入2021年1月至2023年1月期间接受短节段腰椎融合内固定术治疗的退行性腰椎疾病患者。根据不同的引流拔除标准，将患者分为2组（A组和B组）。为控制混杂因素，对两组患者进行1:1最近邻倾向评分匹配，匹配显著变化因素，尤其是年龄、性别、BMI、融合节段数、术中失血量和手术时长。比较两组围手术期结局。进行多因素逻辑回归分析以确定总体并发症的危险因素。
本研究共纳入1004例符合条件的患者，A组676例，B组328例。倾向评分匹配后，最终分析纳入616例患者，每组308例。B组在术后第2天（23.1%对32.1%，p = 0.012）和术后第3天（37.0%对45.1%，p = 0.041）拔除引流的患者明显更多。此外，B组患者术后下床活动时间更早（3.87±1.12对2.41±1.34，p = 0.012）。两组在有症状血肿和手术部位感染方面无显著差异，但B组总体并发症明显更少（10.39%对5.19%，p = 0.016）。多因素逻辑回归表明，术后下床活动时间（OR 2.38，95%CI 1.19 - 3.97，p < 0.001）与总体并发症独立相关。
在本研究中，我们发现放宽引流拔除标准可显著缩短住院时间，此外，还可促进患者术后早期下床活动，从而减少围手术期总体并发症的发生。
