Zaidi Zuhair, Mohamed Asim, Homayoun Billal, Wahid Muaz, Aoun Salah, Van Hal Michael
UT Southwestern Medical School, Dallas, TX, USA.
Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
Global Spine J. 2025 Sep 1:21925682251371593. doi: 10.1177/21925682251371593.
Study DesignRetrospective cohort study.ObjectivesTo assess the effect of alcohol, nicotine, and opioid use history on 90 day and 1 year postoperative complications after elective laminectomy.MethodsUsing the TriNetX Database (2004-2025), adult patients undergoing elective laminectomy were divided into cohorts with a history of alcohol, nicotine, or opioid abuse/dependence, matched 1:1 with controls (age, sex, race, body mass index, comorbidities). Exclusions included malignancy, preceding trauma, and prior complications. Outcomes included the development of acute kidney failure, sepsis, emergency department visits, deep vein thrombosis, myocardial infarction, pulmonary embolism, pneumonia, stroke, and mortality at 90 days and 1 year.ResultsMatched cohorts comprised 4053 alcohol, 22 469 nicotine, and 2724 opioid patients, each with controls. Alcohol abuse was significantly associated with increased odds of death, DVT, MI, pneumonia, sepsis, and stroke following elective laminectomy at 90 days, and with acute renal failure, PE, pneumonia, stroke, sepsis, DVT, and death at 1 year ( < 0.05). Nicotine dependence significantly elevated the risk of death, MI, pneumonia, and sepsis at 90 days, and at 1 year, remained associated with increased odds of acute renal failure, stroke, ED visits, MI, pneumonia, sepsis, and death ( < 0.05). Opioid abuse was significantly linked to higher risks of DVT, MI, pneumonia, sepsis, stroke, and death at 90 days, with persistent 1-year risks for acute renal failure, MI, pneumonia, sepsis, and death ( < 0.05).ConclusionsAlcohol, nicotine, and opioid use significantly heighten postoperative complications after laminectomy, underscoring the need for preoperative risk evaluation and tailored interventions.
研究设计
回顾性队列研究。
目的
评估酒精、尼古丁和阿片类药物使用史对择期椎板切除术后90天和1年术后并发症的影响。
方法
使用TriNetX数据库（2004 - 2025年），将接受择期椎板切除术的成年患者分为有酒精、尼古丁或阿片类药物滥用/依赖史的队列，并与对照组（年龄、性别、种族、体重指数、合并症）进行1:1匹配。排除标准包括恶性肿瘤、既往创伤和先前的并发症。观察指标包括急性肾衰竭、脓毒症、急诊就诊、深静脉血栓形成、心肌梗死、肺栓塞、肺炎、中风以及90天和1年时的死亡率。
结果
匹配队列包括4053名有酒精使用史、22469名有尼古丁使用史和2724名有阿片类药物使用史的患者，每组均有对照组。酒精滥用与择期椎板切除术后90天时死亡、深静脉血栓形成、心肌梗死、肺炎、脓毒症和中风的几率增加显著相关，与1年时急性肾衰竭、肺栓塞、肺炎、中风、脓毒症、深静脉血栓形成和死亡也显著相关（P < 0.05）。尼古丁依赖在90天时显著提高了死亡、心肌梗死、肺炎和脓毒症的风险，在1年时，仍与急性肾衰竭、中风、急诊就诊、心肌梗死、肺炎、脓毒症和死亡的几率增加相关（P < 0.05）。阿片类药物滥用与90天时深静脉血栓形成、心肌梗死、肺炎、脓毒症、中风和死亡的较高风险显著相关，在1年时，急性肾衰竭、心肌梗死、肺炎、脓毒症和死亡仍有持续风险（P < 0.05）。
结论
酒精、尼古丁和阿片类药物的使用显著增加了椎板切除术后的术后并发症，强调了术前风险评估和针对性干预的必要性。
