Risk factors for medical complication after cervical spine surgery: a multivariate analysis of 582 patients.
Risk factors for medical complication after cervical spine surgery: a multivariate analysis of 582 patients.
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DOI：
10.1097/brs.0b013e318268ffc9
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发表时间：
2013-02-01
期刊：
影响因子：
3
通讯作者：
Chapman J
中科院分区：
文献类型：
--
作者：
Lee MJ;Konodi MA;Cizik AM;Weinreich MA;Bransford RJ;Bellabarba C;Chapman J
使用多变量分析对前瞻性收集的登记数据进行多变量分析，以确定颈椎手术后医疗并发症的重要危险因素。有几项研究考察了脊柱手术后的内科并发症的发生情况。然而，这些研究中有许多是利用大型国家数据库进行的。虽然这些允许对数千名患者进行分析，但这些回溯性研究中没有考虑到潜在的有影响的协变量。此外，这些数据库中的这些回溯性数据收集的准确性受到了质疑。脊柱最终结果登记处(2003-2004)收集了我们两个机构接受脊柱手术的所有患者的前瞻性数据。按照米孜等人之前的描述，前瞻性地记录了大量的人口和医学信息。并发症是事先详细定义的，并在术后至少两年内进行前瞻性记录。我们用单因素分析和多因素分析分析了腰椎手术后医疗并发症的危险因素。我们分析了582名符合纳入标准的患者的数据。颈椎手术后各脏器系统并发症的累积发生率依次为：心脏8.4%，肺部13%，胃肠3.9%，神经7.4%，血液10.8%，泌尿系统9.2%。颈椎手术后心脏或呼吸系统并发症的发生与2年内死亡显著相关(RR分别为4.32、6.43)。表2和表3分别列出了具有95%可信区间和p值的相对风险值。在考虑颈椎手术治疗时，本研究中确定的危险因素对临床医生和患者都是有益的。未来预测颈椎手术后医疗并发症发生的分析和模型可能对手术决策有进一步的好处。
Multivariate analysis of prospectively collected registry data Using multivariate analysis, to determine significant risk factors for medical complication after cervical spine surgery. Several studies have examined the occurrence of medical complication after spine surgery. However many of these studies have been done utilizing large national databases. While these allow for analysis of thousands of patients, potentially influential co-variates are not accounted for in these retrospective studies. Furthermore, the accuracy of these retrospective data collection in these databases has been called into question. The Spine End Results Registry (2003–2004) is a collection prospectively collected data on all patients who underwent spine surgery at our two institutions. Extensive demographic and medical information were prospectively recorded as described previously by Mirza et al. Complications were defined in detail a priori and were prospectively recorded for at least 2 years after surgery. We analyzed risk factors for medical complication after lumbar spine surgery using univariate and multivariate analysis. We analayzed data from 582 patients who met out inclusion criteria. The cumulative incidences of complication after cervical spine surgery per organ system are as follows: cardiac – 8.4%, pulmonary – 13%, gastrointestinal – 3.9%, neurological – 7.4%, hematological – 10.8% and urologic complications – 9.2%. The occurrence of cardiac or respiratory complication after cervical spine surgery was significantly associated with death within 2 years (RR 4.32, 6.43 respectively). Relative risk values with 95% confidence intervals and p values are listed individually in Tables 2 and 3. Risk factors identified in this study can be beneficial to clinicians and patients alike when considering surgical treatment of the cervical spine. Future analyses and models that predict the occurrence of medical complication after cervical spine surgery may be of further benefit for surgical decision making.