Factors affecting the occurrence of pulmonary embolism after spinal surgery: data from the national administrative database in Japan
Factors affecting the occurrence of pulmonary embolism after spinal surgery: data from the national administrative database in Japan
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DOI：
10.1016/j.spinee.2012.10.020
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发表时间：
2012-12-01
期刊：
影响因子：
4.5
通讯作者：
Nakamura, Kozo
中科院分区：
文献类型：
--
作者：
Masuda, Kazuhiro;Chikuda, Hirotaka;Nakamura, Kozo
背景情况：尽管肺栓塞（PE）具有潜在的破坏性后果，但对脊柱手术患者的肺栓塞仍知之甚少。据我们所知，很少有大型研究调查脊柱手术后PE的患病率和危险因素。目的：调查择期脊柱手术患者中有症状PE的患病率，并确定与术后PE发生相关的临床变量。对诊断程序组合（DPC）数据库（日本全国代表性数据库）中提取的数据进行回顾性分析。患者样本：我们纳入了2007年7月1日至2008年12月31日期间分别接受脊柱手术的所有诊断为椎管狭窄、椎间盘突出、椎关节强硬、脊椎滑脱、创伤、转移瘤或感染的患者，观察指标：主要终点定义为住院期间术后PE的发生率。次要终点是术后PE后的院内死亡。方法：我们分析了术后PE发生率与DPC数据库中记录的临床变量之间的相关性，包括年龄、性别、合并症、手术位置、初步诊断、前/后入路、器械使用和麻醉持续时间。结果：共确定了47，743例患者。其中，50例（0.10%）发生PE，4例因PE死亡。Logistic回归分析显示，PE的发生与年龄较大（≥ 70岁;比值比[OR]，3.15; 95%置信区间[CI]，1.15-8.69; p=5.026）和麻醉时间较长（超过360分钟; OR，2.19; 95% CI，0.88-5.44; p=5.092）相关。创伤患者发生肺栓塞的可能性明显高于椎管狭窄患者（0.27% vs. 0.09%; OR，2.86; 95%CI，1.14-7.18; p=5.026）。结论：对全国代表性数据库的回顾性分析确定年龄较大、麻醉时间较长和脊柱创伤是术后肺栓塞发生率增加的危险因素。外科医生应该意识到这些患者亚组术后PE的风险增加。(C)2012 Elsevier Inc. All rights reserved.
BACKGROUND CONTEXT: Despite potentially devastating consequences, pulmonary embolism (PE) in patients undergoing spinal surgery remains poorly understood. To the best of our knowledge, few large studies have examined the prevalence and risk factors of PE after spinal surgery.PURPOSE: To investigate the prevalence of symptomatic PE in patients undergoing elective spinal surgery and to identify clinical variables associated with the occurrence of postoperative PE.STUDY DESIGN: A retrospective analysis of data abstracted from the diagnosis procedure combination (DPC) database, a nationally representative database in Japan.PATIENT SAMPLE: We included all patients with a diagnosis of spinal canal stenosis, disc herniation, spondylosis, spondylolisthesis, trauma, metastatic tumor, or infection who underwent spinal surgery between July 1 and December 31 of 2007 and 2008, respectively.OUTCOME MEASURES: The primary end point was defined as the occurrence of postoperative PE during hospitalization. The secondary end point was in-hospital death after postoperative PE.METHODS: We analyzed the association between the occurrence of postoperative PE and clinical variables recorded in the DPC database, including age, sex, comorbidities, location of surgery, primary diagnosis, anterior/posterior approach, use of instrumentation, and duration of anesthesia.RESULTS: A total of 47,743 patients were identified. Of these, 50 (0.10%) developed PE and four died as a result of PE. Logistic regression analyses revealed that occurrence of PE was associated with older age (70 years or older; odds ratio [OR], 3.15; 95% confidence interval [CI], 1.15-8.69; p=5.026) and longer anesthesia time (more than 360 minutes; OR, 2.19; 95% CI, 0.88-5.44; p=5.092). Patients with trauma were significantly more likely to have a PE than those with spinal canal stenosis (0.27% vs. 0.09%; OR, 2.86; 95% CI, 1.14-7.18; p=5.026).CONCLUSIONS: This retrospective analysis of a nationally representative database identified older age, longer anesthesia time, and spinal trauma as risk factors for increased incidence of postoperative PE. Surgeons should be aware of the increased risk of postoperative PE in these subgroups of patients. (C) 2012 Elsevier Inc. All rights reserved.