Health-Related Quality of Life Scores Underestimate the Impact of Major Complications in Lumbar Degenerative Scoliosis Surgery.
Health-Related Quality of Life Scores Underestimate the Impact of Major Complications in Lumbar Degenerative Scoliosis Surgery.
复制标题
DOI：
10.1016/j.jspd.2017.05.003
复制
发表时间：
2018-01
期刊：
影响因子：
1.6
通讯作者：
Carreon LY
中科院分区：
文献类型：
--
作者：
Glassman SD;Bridwell KH;Shaffrey CI;Edwards CC 2nd;Lurie JD;Baldus CR;Carreon LY
回顾性队列研究Charlson共病指数（CCMI）作为健康状况恶化的标志，而不是反映在标准健康相关生活质量（HRQOL）测量中。HRQOLs已成为评估脊柱畸形手术后预后的主要指标。然而，研究报告并发症对术后HRQOLs的影响有限。我们研究了138例接受手术治疗的成人腰椎畸形患者的CCMI、并发症和HRQOLs，随访时间至少为两年，其中126例为女性（91%），平均年龄59.8岁（范围40.2-78.5岁）。无、轻微或严重并发症的患者在基线和术后1年和2年进行比较。轻微并发症26例（19%），严重并发症15例（11%）。主要并发症包括运动障碍（7例）、深静脉血栓（4例）和呼吸衰竭（3例）。两组术前SF-36 PCS或SRS评分在基线时无差异。术前CCMI以无并发症组最低（3.52±1.70），其次为严重并发症组（4.00±1.13），轻微并发症组（4.15±1.71,p=0.165）。1年时，严重并发症组CCMI恶化（0.80±1.01）明显高于轻微并发症组（0.08±0.27）和无并发症组（0.27±0.47,p<0.001）。三组间SF-36 PCS和SRS评分无显著差异。两年后观察到类似的结果。尽管有相似的1年和2年HRQOL改善，但主要并发症患者的CCMI恶化更大。由于CCMI可预测医疗和手术风险，因此持续发生重大并发症的患者在未来的干预措施（包括随后的脊柱手术）中出现不良后果的可能性更大。虽然这种增加的风险可能不会改变患者对其目前健康状况的看法，但它可能很重要，应该被视为共同决策过程的一部分。II（高质素预后研究）
Retrospective cohort To examine Charlson Comorbidity Index (CCMI) as a marker for deterioration in health status not reflected in standard Health Related Quality of Life (HRQOL) measures. HRQOLs have become a primary metric for assessing outcomes following spinal deformity surgery. However, studies have reported limited impact of complications on postoperative HRQOLs. We examined serial CCMI, complications and HRQOLs for 138 adult lumbar deformity patients treated surgically with a minimum two-year follow-up that included 126 females (91%) with a mean age of 59.8 years (range, 40.2–78.5). Patients with No, Minor or Major complications were compared at baseline and at one- and two-years post-op. Minor complications were observed in 26 patients (19%) and major complications in 15 (11%). Major complications included motor deficit (7), DVT (4) and respiratory failure (3). There was no difference in pre-op SF-36 PCS or SRS scores among the groups at baseline. Pre-op CCMI was lowest in the No complication group (3.52±1.70) followed by the Major (4.00±1.13) and Minor complication groups (4.15±1.71, p=0.165). At one-year, there was a significantly greater CCMI deterioration in the Major complication group (0.80±1.01) compared to both the Minor (0.08±0.27) and No complication groups (0.27±0.47, p<0.001). There was no significant difference in SF-36 PCS or SRS scores among the three groups. Similar findings were observed at two-years. Despite similar one and two-year HRQOL improvement, patients with major complications had greater deterioration in CCMI. As CCMI is predictive of medical and surgical risk, patients who sustained a major complication now carry a greater likelihood of adverse outcomes with future interventions including any subsequent spinal surgery. While this increased risk may not alter the patient’s perception of their current health status, it may be important, and should be recognized as part of the shared decision-making process. II (High Quality Prognostic Study)