Unplanned Return to the Operating Room in Patients With Adolescent Idiopathic Scoliosis: Are We Doing Better With Pedicle Screws?
Unplanned Return to the Operating Room in Patients With Adolescent Idiopathic Scoliosis: Are We Doing Better With Pedicle Screws?
复制标题
青少年特发性脊柱侧凸患者意外返回手术室：椎弓根螺钉治疗效果更好吗？
作者：
A. Samdani;Eric J. Belin;J. T. Bennett;J. Pahys;M. Marks;F. Miyanji;H. Shufflebarger;B. Lonner;P. Newton;R. Betz;P. Cahill
研究设计。前瞻性、纵向队列研究。目标。评估青少年特发性脊柱侧凸（AIS）患者经椎弓根螺钉（PSs）与混合型（Hb）治疗后再手术的发生率、时机和危险因素。背景资料摘要。由于缺乏关于PS结构的数据，AIS的明确融合后返回手术室（OR）的比率各不相同。方法。回顾性查询前瞻性多中心数据库，以确定连续接受PS或Hb结构后路脊柱融合术的AIS患者，随访至少2年。再手术分为早期组（<60 d）和晚期组（<60 d）。进行单因素和多因素logistic分析，以确定与再手术相关的潜在危险因素。结果。共有627例患者符合纳入标准（PS = 540, Hb = 87）。PS组再手术率为3.5%，Hb组再手术率为12.6%，差异有统计学意义（P < 0.001）。与Hb组的3.4%相比，2.0%的PS患者早期返回手术室，P = 0.43。PS组延迟返回手术室的比例为1.5%，Hb组为9.2%,P < 0.001。多因素分析显示，手术时间延长是PSs患者意外返回手术室的独立危险因素（P < 0.05）。结论。我们的研究结果表明，与Hb结构的患者相比，接受PS治疗的AIS患者意外返回手术室的比率降低。与Hb组相比，PS组大多数返回手术室的时间较早（<60 d），而Hb组较晚（60 d）。较长的手术时间增加了PS组意外再手术的风险。证据等级：3
Study Design. Prospective, longitudinal cohort. Objective. To evaluate the incidence, timing, and risk factors for reoperation in patients with adolescent idiopathic scoliosis (AIS) treated with pedicle screws (PSs) compared with hybrid (Hb) constructs. Summary of Background Data. Rates of return to the operating room (OR) after definitive fusion for AIS vary, with a paucity of data on PS constructs. Methods. A prospective multicenter database was retrospectively queried to identify consecutive patients with AIS who underwent posterior spinal fusion with either PS or Hb constructs with a minimum 2-year follow-up. All reoperations were stratified into an early group (<60 d) or a late group (>60 d). Univariate and multivariate logistical analyses were performed to identify potential risk factors related to reoperation. Results. A total of 627 patients met the inclusion criteria (PS = 540, Hb = 87). There was a statistically significant difference in the rate of reoperations between the PS (3.5%) and Hb groups (12.6%), P < 0.001. Early return to the OR occurred in 2.0% of the patients with PS compared with 3.4% in the Hb group, P = 0.43. Late returns to the OR occurred in 1.5% of PS group versus 9.2% of the Hb group, P < 0.001. Multivariate analysis revealed longer operating time as an independent risk factor for an unplanned return to the OR in patients treated with PSs (P < 0.05). Conclusion. Our results suggest that patients with AIS treated with PS have decreased rates of unplanned return to the OR when compared with patients with Hb constructs. The majority of returns to the OR were early (<60 d) for the PS group compared with late (>60 d) for the Hb group. Longer operative times increased the risk of unplanned reoperation for the PS group. Level of Evidence: 3