Effects of age on perioperative complications of extensive multilevel thoracolumbar spinal fusion surgery.
Effects of age on perioperative complications of extensive multilevel thoracolumbar spinal fusion surgery.
复制标题
年龄对广泛多节段胸腰椎融合手术围手术期并发症的影响。
DOI：
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发表时间：
2010
期刊：
影响因子：
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通讯作者：
C. Ames
中科院分区：
文献类型：
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作者：
J. Cloyd;Frank L. Acosta;C. Cloyd;C. Ames
对象
老年人构成了呈现复杂脊柱病理的患者的相当大比例。最近的几项研究表明，融合4个或更多节段会增加老年患者围手术期并发症的风险。因此，这项研究的目的是分析年龄对接受多节段(>；或=5节段)胸腰椎融合手术患者的影响。
方法
对2000年至2007年间连续接受手术的124名患者进行了所有医院记录、手术报告和临床记录的回顾，平均随访时间为3.5年，最低随访时间为1.2年。最常见的术前诊断包括脊柱侧弯、肿瘤、骨髓炎、椎体骨折和退行性腰椎间盘疾病伴狭窄。并发症分为术中并发症、术后主要并发症和轻微并发症，以及需要翻修手术。多因素Logistic回归分析确定年龄和其他潜在预后因素的影响。
结果
在控制其他因素后，年龄增加与术后主要并发症的风险增加(OR 1.04，95%CI 1.00~1.10)以及增加融合程度(OR 1.5，95%CI 1.1~2.1)和男性(OR 4.6，95%CI 1.3~16.2)相关。65岁以上患者术中并发症发生率为14.1%，术后并发症发生率为23.4%，术后主要并发症发生率为29.7%，再次手术发生率为26.6%。老年患者合并合并症的数量与围手术期并发症的风险增加相关(OR 1.8，95%CI 1.1-2.8)。
结论
年龄是广泛胸腰椎融合术主要术后并发症的积极危险因素。老年人的并发症发生率很高，在对老年人进行广泛的胸腰椎重建术之前，需要良好的临床判断力和仔细的患者选择。
OBJECT
The elderly compose a substantial proportion of patients presenting with complex spinal pathology. Several recent studies have suggested that fusion of 4 or more levels increases the risk of perioperative complications in elderly patients. Therefore, the purpose of this study was to analyze the effects of age in persons undergoing multilevel (> or = 5 levels) thoracolumbar fusion surgery.
METHODS
A retrospective review of all hospital records, operative reports, and clinic notes was conducted for 124 consecutive patients who underwent surgery between 2000 and 2007 with an average follow-up of 3.5 years and a minimum follow-up of 1.2 years. The most frequent preoperative diagnoses included scoliosis, tumor, osteomyelitis, vertebral fracture, and degenerative disc disease with stenosis. Complications were classified as intraoperative and major and minor postoperative as well as the need for revision surgery. Multivariate logistic regression analysis was used to determine the effects of age and other potentially prognostic factors.
RESULTS
After controlling for other factors, increasing age was associated with an elevated risk for major postoperative complications (OR 1.04, 95% CI 1.00-1.10) as were increasing levels of fusion (OR 1.5, 95% CI 1.1-2.1) and male sex (OR 4.6, 95% CI 1.3-16.2). In patients 65 years of age or older, rates of intraoperative complications, major and minor postoperative complications, and reoperation were 14.1, 23.4, 29.7, and 26.6%, respectively. The number of comorbidities was associated with a greater risk for perioperative complications in elderly patients (OR 1.8, 95% CI 1.1-2.8).
CONCLUSIONS
Age is a positive risk factor for major postoperative complications in extensive thoracolumbar spinal fusion surgery. Complication rates in the elderly are high, and good clinical judgment and careful patient selection are needed before performing extensive thoracolumbar reconstruction in older persons.