Longer Operative Time in Elderly Patients Undergoing Posterior Lumbar Fusion Is Independently Associated With Increased Complication Rate
Longer Operative Time in Elderly Patients Undergoing Posterior Lumbar Fusion Is Independently Associated With Increased Complication Rate
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DOI：
10.1177/2192568218789117
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发表时间：
2019-04-01
影响因子：
2.4
通讯作者：
Daniels, Alan H.
中科院分区：
文献类型：
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作者：
Hersey, Alicia E.;Durand, Wesley M.;Daniels, Alan H.
研究设计：回顾性队列研究。目的：确定手术时间对65岁及以上患者行后路腰椎融合术的术后并发症的影响。研究方法：在2012年至2015年美国外科医师学会国家手术质量改进计划数据库中识别了所有接受后路腰椎融合术的65岁及以上患者。主要结局指标为术后30天内发生的并发症，包括死亡、任何并发症和并发症亚型。主要自变量为手术时间。双变量和多变量分析均采用逻辑回归，并将手术持续时间作为连续变量进行分析。统计学显著性被认为是P < .05。结果：共确定了4947例年龄在65岁及以上接受后路腰椎融合术的患者。平均手术时间为3.3小时（SD 1.7）。总体并发症发生率为13.4%（n = 665）。在多变量分析中，手术时间每增加1小时与术后血栓栓塞风险增加相关（比值比[OR] = 1.23; 95%置信区间[CI] = 1.10-1.37），输血（OR= 1.25; 95% CI = 1.18-1.32）、尿路感染（OR = 1.21; 95% CI = 1.10-1.32）和术后总并发症（OR = 1.22; 95% CI = 1.16-1.27）。结论：对于65岁及以上接受后路腰椎融合术的患者，手术时间越长，血栓栓塞、输血、插管、肾损伤、尿路感染、手术部位感染和总体术后并发症的风险越大。该数据强调了老年患者中受手术时间影响的几种特定并发症，并进一步支持了寻求安全地最大限度缩短后路腰椎融合术手术时间的未来方案的需求。
Study Design: Retrospective cohort study. Objective: To determine the effects of operative time on postoperative complications in patients age 65 and older undergoing posterior lumbar fusion. Methods: All patients age 65 and older undergoing posterior lumbar fusion were identified in the 2012 to 2015 American College of Surgeons National Surgical Quality Improvement Program database. The primary outcome measures were complications occurring up to 30 days postoperatively, including death, any complication, and complication subtypes. The primary independent variable was operative duration. Both bivariate and multivariate analyses utilized logistic regression and analyzed operative duration as a continuous variable. Statistical significance was considered P < .05. Results: A total of 4947 patients age 65 and older undergoing posterior lumbar fusion were identified. The mean operative time was 3.3 hours (SD 1.7). The overall complication rate was 13.4% (n = 665). In multivariate analysis, each incremental hour of operative time was associated with increased risk of postoperative thromboembolism (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.10-1.37), transfusion (OR= 1.25; 95% CI = 1.18-1.32), urinary tract infection (OR = 1.21; 95% CI = 1.10-1.32), and total postoperative complications (OR = 1.22; 95% CI = 1.16-1.27). Conclusion: For patients age 65 and older undergoing posterior lumbar fusion, longer operative time is associated with greater risk for thromboembolism, transfusion, intubation, kidney injury, urinary tract infection, surgical site infection, and overall postoperative complications. This data highlights several specific complications that are influenced by operative time in older patients, and further supports the need for future protocols that seek to safely minimize operative time for posterior lumbar fusion.