Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease
Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease
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DOI：
10.3171/2017.10.jns171749
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发表时间：
2019-02-01
影响因子：
4.1
通讯作者：
Zhao, Jizong
中科院分区：
文献类型：
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作者：
Zhao, Meng;Deng, Xiaofeng;Zhao, Jizong
目的烟雾病术后并发症的危险因素及临床意义尚不清楚。本研究的目的是调查烟雾病术后并发症的预测因素，并检查并发症对预后的影响。方法作者回顾了2009至2015年间在他们的医院接受间接、直接或联合搭桥手术的成年烟雾病患者的连续病例。记录术前临床特征和X线表现。观察术后14天内并发症的发生率。采用多因素Logistic回归分析确定术后脑缺血或术后脑过度灌注的危险因素。结果数据，包括复发性中风和随访期间的神经状态(改良Rankin评分[MRS])，被收集。对有并发症的患者和无并发症的患者的预后进行比较，使用倾向分数分析来说明组间基线特征的差异。结果共有500名患者(610个大脑半球)参与研究。术后并发症74例(12.1%)，其中术后新发缺血30例(4.9%)，过度灌注27例(4.4%)，创面愈合不良12例(2.0%)，硬膜下积液6例(1.0%)。不同术式的并发症发生率分别为：间接搭桥术12.6%(n=25)，直接搭桥术12.7%(n=37)，联合搭桥术10.0%(n=0.726)。术后30个半球(4.9%)发生缺血并发症，其中27例(4.4%)术后出现症状性高血流。晚期铃木分期(OR 1.669，95%CI 1.059~2.632，p=0.027)和术前缺血表现(OR 5.845，95%CI 1.654~20.653，p=0.006)与术后缺血显著相关。术前脑缺血表现(OR5.73，95%CI1.27~25.88，p=0.023)和入院改良Rankin评分(OR1.81，95%CI1.06~3.10，p=0.031)与症状性术后脑高灌注综合征显著相关。与无术后并发症的患者相比，有任何术后并发症的患者住院时间更长，出院时MRS评分更差(P<；0.0001)。在最终随访时，两组患者的功能障碍(MRS评分3-6分，11.9%比4.5%，P=0.116)和未来的卒中事件(P=0.513)均无显著差异。结论晚期铃木分期和术前脑缺血表现是术后脑缺血的独立危险因素；入院时MRS评分和术前脑缺血表现与术后脑缺血独立相关。虽然有术后并发症的患者在出院时的神经状况较差，但术后并发症与未来的中风事件或随访期间的功能残疾没有相关性。
OBJECTIVE The risk factors and clinical significance of postoperative complications in moyamoya disease are still unclear. The aim of this study was to investigate the predictors of postoperative complications in moyamoya disease and examine the impact of complications on outcomes.METHODS The authors reviewed consecutive cases involving adult moyamoya disease patients who underwent indirect, direct, or combined bypass surgery in their hospital between 2009 and 2015. Preoperative clinical characteristics and radiographic features were recorded. Postoperative complications within 14 days after surgery were examined. Multivariate logistic regression analyses were performed to identify the risk factors for either postoperative ischemia or postoperative cerebral hyperperfusion. Outcome data, including recurrent strokes and neurological status (modified Rankin Scale [mRS]) during follow-up, were collected. Outcomes were compared between patients who had complications with those without complications, using propensity-score analysis to account for between-group differences in baseline characteristics.RESULTS A total of 500 patients (610 hemispheres) were included in this study. Postoperative complications were observed in 74 operations (12.1%), including new postoperative ischemia in 30 cases (4.9%), hyperperfusion in 27 (4.4%), impaired wound healing in 12 (2.0%), and subdural effusion in 6 (1.0%). The complication rates for different surgery types were as follows: 12.6% (n = 25) for indirect bypass, 12.7% (n = 37) for direct bypass, and 10.0% (n = 12) for combined bypass (p = 0.726). Postoperative ischemic complications occurred in 30 hemispheres (4.9%) in 30 different patients, and postoperative symptomatic hyperperfusion occurred after 27 procedures (4.4%). Advanced Suzuki stage (OR 1.669, 95% CI 1.059-2.632, p = 0.027) and preoperative ischemic presentation (OR 5.845, 95% CI 1.654-20.653, p = 0.006) were significantly associated with postoperative ischemia. Preoperative ischemic presentation (OR 5.73, 95% CI 1.27-25.88, p = 0.023) and admission modified Rankin Scale (mRS) score (OR 1.81, 95% CI 1.06-3.10, p = 0.031) were significantly associated with symptomatic postoperative cerebral hyperperfusion syndrome (CHS). Compared with patients without postoperative complications, patients who experienced any postoperative complications had longer hospital stays and worse mRS scores at discharge (both p < 0.0001). At the final follow-up, no significant differences in functional disability (mRS score 3-6, 11.9% vs 4.5%, p = 0.116) and future stroke events (p = 0.513) between the 2 groups were detected.CONCLUSIONS Advanced Suzuki stage and preoperative ischemic presentation were independent risk factors for postoperative ischemia; the mRS score on admission and preoperative ischemic presentation were independently associated with postoperative CHS. Although patients with postoperative complications had worse neurological status at discharge, postoperative complications had no associations with future stroke events or functional disability during follow-up.