Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Spondylotic Myelopathy Propensity Score Matching Analysis Using a Nationwide Inpatient Database
Comparison of Perioperative Complications in Anterior Decompression With Fusion and Posterior Decompression With Fusion for Cervical Spondylotic Myelopathy Propensity Score Matching Analysis Using a Nationwide Inpatient Database
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DOI：
10.1097/bsd.0000000000001209
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发表时间：
2021-08-01
影响因子：
1.9
通讯作者：
Fujiwara, Takeo
中科院分区：
文献类型：
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作者：
Morishita, Shingo;Yoshii, Toshitaka;Fujiwara, Takeo
研究设计：以国家住院患者数据库为基础的回顾性队列研究。目的：利用全国大型住院患者数据库和倾向评分匹配(PSM)分析，研究脊髓型颈椎病(CSM)患者前路减压融合术(ADF)和后路减压融合术(PDF)围手术期并发症发生率。背景资料摘要：有几种方法可以成功地在CSM患者中实现手术减压；然而，缺乏ADF和PDF中全身并发症和再手术率的证据。材料和方法：利用日本诊断程序组合数据库，我们确定了2010-2016年间因CSM住院并接受ADF或PDF治疗的患者。在ADF组和PDF组中，我们比较了术后并发症(全身和局部)、住院期间的医疗费用以及PSM前后的死亡率。此外，对围术期全身并发症的危险因素进行了多元回归分析。结果：PSM后共配对1013对。围手术期并发症ADF组多于PDF组(至少1例并发症：ADF组15.2%比PDF组12.0%，P=0.038)，尤其是呼吸衰竭(1.4%比0.4%，P=0.018)、肺炎(1.9%比0.5%，P=0.004)和吞咽困难(3.0%比1.1%，P=0.003)。成本与高出8000美元的成本相近(P
Study Design: A retrospective cohort study with a national inpatient database. Objective: This study aimed to research the perioperative complication rates of cervical spondylotic myelopathy (CSM) patients who underwent anterior decompression with fusion (ADF) and posterior decompression with fusion (PDF) using a large national inpatient database and propensity score matching (PSM) analysis. Summary of Background Data: There are several ways to successfully achieve surgical spinal decompression in CSM patients; however, evidence of the systemic complications and reoperation rates in ADF and PDF is lacking. Materials and Methods: We identified patients who were hospitalized for CSM and underwent either ADF or PDF from 2010 to 2016 using the Japanese Diagnosis Procedure Combination database. In the ADF and PDF groups, we compared postoperative complications (systemic and local), medical costs during hospitalization, and mortality before and after PSM. In addition, multivariate regression analysis was performed to identify risk factors for perioperative systemic complications. Results: A total of 1013 matched pairs were made after PSM. More perioperative systemic complications were detected in the ADF group than in the PDF group (at least 1 complication: ADF vs. PDF: 15.2% vs. 12.0%, P=0.038), especially for respiratory failure (1.4% vs. 0.4%, P=0.018), pneumonia (1.9% vs. 0.5%, P=0.004), and dysphagia (3.0% vs. 1.1%, P=0.003). The costs were similar to$8000 higher (P