Mortality and Morbidity in Dialysis-Dependent Patients Undergoing Spinal Surgery Analysis of a National Administrative Database in Japan
Mortality and Morbidity in Dialysis-Dependent Patients Undergoing Spinal Surgery Analysis of a National Administrative Database in Japan
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DOI：
10.2106/jbjs.k.00183
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发表时间：
2012-03-07
影响因子：
5.3
通讯作者：
Nakamura, Kozo
中科院分区：
文献类型：
--
作者：
Chikuda, Hirotaka;Yasunaga, Hideo;Nakamura, Kozo
背景：透析依赖对脊柱手术后围手术期风险的影响尚不完全清楚。本研究的目的是确定接受脊柱手术治疗的依赖透析的患者的围手术期风险，并检查破坏性脊柱关节病的存在是否会进一步增加围手术期风险。 方法：我们在对全国代表性住院患者数据库进行回顾性分析时，检查了从诊断程序组合数据库中提取的数据。该数据库的调查每年进行一次，为期六个月，时间为7月1日至12月31日。本研究使用2007年和2008年的数据。我们纳入了所有接受过椎板切除术、椎板成形术、椎间盘切除术和/或脊柱关节融合术任意组合的患者。为了进行分析，依赖透析的患者被进一步分为患有或不患有破坏性脊柱关节病的亚组。结果：我们确定了 51,648 名符合条件的患者（30,743 名男性和 20,905 名女性；平均年龄为 62 岁），其中 869 名（1.7%）依赖透析的患者。后者中，九十五人患有破坏性脊柱关节病。总体院内死亡率为 0.41%。依赖透析的患者的院内死亡率显着高于非依赖透析的患者。调整后，依赖透析的患者院内死亡风险仍然高出十倍。依赖透析的患者发生术后主要并发症的风险也显着增加。依赖透析的破坏性脊柱关节病患者的并发症发生率比无破坏性脊柱关节病的患者高65%，但这种差异并未达到显着性。结论：依赖透析的患者的院内死亡风险比非依赖透析的患者高10倍。依赖透析的患者也更有可能出现心脏事件、败血症和呼吸系统并发症等主要并发症。我们的数据还表明，破坏性脊柱关节病的存在与依赖透析的患者术后并发症发生率较高有关。
Background: The impact of dialysis dependence on perioperative risks following spinal surgery is not fully understood. The purposes of the present study were to determine the perioperative risks in dialysis-dependent patients treated with spinal surgery and to examine whether the presence of destructive spondyloarthropathy further increases perioperative risks.Methods: We examined abstracted data from the Diagnosis Procedure Combination database in a retrospective analysis of a nationally representative inpatient database. The survey of the database is conducted annually for a six-month period between July 1 and December 31. The data from 2007 and 2008 were used for this study. We included all patients who had undergone any combination of,laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis. For analysis, dialysis-dependent patients were further classified into subgroups with or without destructive spondyloarthropathy.Results: We identified 51,648 eligible patients (30,743 men and 20,905 women; mean age, sixty-two years), including 869(1.7%) who were dialysis-dependent. Of the latter, ninety-five had destructive spondyloarthropathy. Overall in-hospital mortality was 0.41%. Dialysis-dependent patients had a significantly higher in-hospital mortality rate than non-dialysis-dependent patients. After adjustment, dialysis-dependent patients remained at a tenfold higher risk for in-hospital death. Dialysis-dependent patients were also at significantly greater risk for postoperative major complications. The rate of complications in dialysis-dependent patients with destructive spondyloarthropathy was 65% higher than that in those without destructive spondyloarthropathy, but this difference did not reach significance.Conclusions: Dialysis-dependent patients had a tenfold higher risk of in-hospital death than did non-dialysis-dependent patients. Dialysis-dependent patients were also more likely to have major complications such as cardiac events, sepsis, and respiratory complications. Our data also indicate that the presence of destructive spondyloarthropathy is associated with a higher rate of postoperative complications in dialysis-dependent patients.,