Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis - An analysis of 166 patients
Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis - An analysis of 166 patients
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DOI：
10.1097/01.brs.0000251918.19508.b3
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发表时间：
2007-01-15
期刊：
影响因子：
3
通讯作者：
Bohlman, Henry H.
中科院分区：
文献类型：
--
作者：
Cassinelli, Ezequiel H.;Eubanks, Jason;Bohlman, Henry H.
研究设计。回顾review.Objective。量化和描述大量匹配良好的老年患者行腰椎减压和关节融合术的围手术期并发症发生率。背景资料摘要。后路腰椎减压融合术常用于治疗伴有不稳定的腰椎管狭窄症。越来越多的老年患者接受手术治疗退行性腰椎疾病。文献中报道的这一人群进行减压和关节融合术的发病率差异很大，最近的报道显示主要并发症的发生率很高。共纳入166例65岁及以上的患者，这些患者接受了初级后路腰椎减压融合术，有（组1，n = 75）或没有（组2，n = 91）内固定。查看了医院记录，以了解任何并发症（主要和次要）的发生、输血的需要、估计住院时间和出院时的处置情况。采用Logistic回归（以主要并发症是否存在为因变量）来确定并发症发生的危险因素。发生5例主要并发症（3%）（1、1组；2、4组）。第1组和第2组的轻微并发症发生率分别为30.7%和31.9%。无死亡病例，只有一例围手术期并发症可归因于器械的使用。4个或更多节段的减压/融合与主要并发症的发生显著相关。高龄、医疗合并症的存在或使用器械不会增加主要或次要并发症的发生率。主要或次要并发症的发生延长了住院时间。后路腰椎减压融合术可以安全地在老年患者中进行，主要并发症发生率低。增加内固定装置不会增加并发症发生率。这些结果与先前文献报道的结果不同，先前文献描述了该年龄组的并发症发生率明显较高，住院率较长。
Study Design. Retrospective review.Objective. To quantify and describe perioperative complication rates in a large series of well-matched elderly patients who underwent lumbar decompression and arthrodesis.Summary of Background Data. Posterior lumbar decompression and fusion is frequently performed to treat lumbar stenosis with instability. An increasing number of elderly patients are undergoing operative treatment for degenerative lumbar disease. The reported morbidity of performing decompression and arthrodesis in this population varies widely in the literature, with recent reports showing a high rate of major complications.Methods. A total of 166 patients age 65 or older that underwent primary posterior lumbar decompression and fusion with (group 1; n = 75) or without (group 2; n = 91) instrumentation were included. Hospital records were reviewed for the occurrence of any complications (major and minor), the need for transfusion, estimated length of stay, and disposition at discharge. Logistic regression (with the presence/absence of major complications as the dependent variable) was used to identify risk factors for the occurrence of a complication.Results. Five major complications (3%) occurred (group 1, 1; group 2, 4). Minor complications developed in 30.7% of group 1 and 31.9% of group 2. There were no deaths, and only one perioperative complication was attributable to the use of instrumentation. Decompression/fusion of 4 or more segments was significantly associated with the occurrence of a major complication. Advanced age, the presence of medical comorbidities, or the use of instrumentation did not increase the rate of major or minor complications. The occurrence of either a major or minor complication prolonged hospital stay.Conclusions. Posterior lumbar decompression and fusion can be safely performed in elderly patients, with a low rate of major complications. The addition of instrumentation does not increase the complication rate. These results differ from those previously reported in the literature, which describe a significantly higher rate of complications in this age group, with a prolonged rate of hospitalization.