The Morbidity and Mortality of Fusions from the Thoracic Spine to the Pelvis in the Adult Population
The Morbidity and Mortality of Fusions from the Thoracic Spine to the Pelvis in the Adult Population
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DOI：
10.1097/brs.0b013e3181f453e2
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发表时间：
2011-08-01
期刊：
影响因子：
3
通讯作者：
Chapman, Jens R.
中科院分区：
文献类型：
--
作者：
Howe, Christopher R.;Agel, Julie;Chapman, Jens R.
研究设计.一个回顾性分析。量化手术风险并探索早期围手术期并发症与患者人口统计学和手术变量的相关性。背景数据总结。从胸椎延伸到骨盆的长融合在成人中越来越常见。目前，很少有研究详细说明这种全面重建的总体风险或术前人口统计学与潜在并发症的关系。在两个三级转诊机构进行了回顾性研究。分析术前患者人口统计学和术中手术变量，以探索与结局的潜在相关性。记录的结局包括死亡、住院和重症监护室（ICU）住院时间、出院到康复机构、主要医疗并发症、神经功能缺损以及患者随后接受的额外计划外手术。2003年至2007年，103例连续患者因退行性疾病接受了从胸椎到骨盆的融合术。有4%的死亡率。平均住院时间和平均ICU住院时间分别为12 +/-7天和2.7 +/-4天。58%的患者出院到康复机构。12%的患者经历至少一种主要的医疗并发症。17%的患者有记录的新的持续性神经功能缺损，在最终诊所访视时仍然存在。35%的患者至少有一次计划外返回手术室。没有围手术期人口统计学或手术变量与死亡率有统计学显著相关性。主要内科并发症与美国麻醉医师协会（ASA）评分（P = 0.030）和Charlson合并症指数（P = 0.028）有关，但与年龄无关（P = 0.273）。尽管有更先进的手术和围手术期技术，但涉及胸椎到骨盆融合的复杂脊柱重建仍然是一种高风险手术。
Study Design. A retrospective analysis.Objective. To quantify the risks of surgery and explore the associations of early perioperative complications with patient demographics and surgical variables.Summary of Background Data. Long fusions extending from the thoracic spine to the pelvis in adults are increasingly common. Currently, there are few studies detailing the overall risks of such comprehensive reconstructions or how preoperative demographics may be associated with potential complications.Methods. A retrospective study was performed at two tertiary referral institutions. Preoperative patient demographics and intraoperative surgical variables were analyzed to explore the potential association with outcomes. The outcomes recorded were death, length of hospital and intensive care unit (ICU) stay, discharge to a rehabilitation facility, major medical complications, neurologic deficits, and the additional unplanned surgeries that patients subsequently underwent.Results. One hundred three consecutive patients underwent a fusion extending from the thoracic spine to the pelvis for degenerative conditions from 2003 to 2007. There was a 4% mortality rate. The mean hospital stay and mean ICU stay was 12 +/- 7 and 2.7 +/- 4 days, respectively. Fifty-eight percent of patients were discharged to a rehabilitation facility. Twelve percent of patients experience at least one major medical complication. Seventeen percent of patients had a documented new persistent neurologic deficit that was still present at the final clinic visit. Thirty-five percent of patients underwent at least one unplanned return to the operating theater. There were no perioperative demographics or surgical variables that had a statistically significant association with mortality. Major medical complications were associated with the American Society of Anesthesiologists' (ASA) score (P = 0.030) and the Charlson Comorbidity Index (P = 0.028) but not age (P = 0.273).Conclusion. Complex spine reconstruction involving fusions from the thoracic spine to the pelvis continues to be a high-risk procedure in spite of more advanced surgical and perioperative techniques.