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2014년 5월 26일 월요일

Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery

Brief review

전방, 후방 그리고 전/후방 척추 유합술 후의 합병증 및 사망률에 대해 연구한 논문 입니다.
National Inpatient Sample을 이용해 해당기간동안 전방, 후방 그리고 전/후방 척추 유합술을 시행한 입원환자의 표본을 구하여 사망률, 동반질환 발병률, 합병증 발병률 등을 조사하고 사망률에 대한 risk factor를 알아보았습니다.
결론적으로, 전방 및 전/후방 척추 유합술 환자들이 후방 경유 환자에 비해 더 젊고 동반질환의 발병률이 적었지만 사망률은 더 높았습니다.

*Title: Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery

*Authors: Stavros G. Memtsoudis , Vassilios I. Vougioukas, Yan Ma, Licia K. Gaber-Baylis, Federico P. Girardi
*Bilbiography: Spine (Phila Pa 1976). 2011 Oct 15;36(22):1867-77.

Analysis of population-based national hospital discharge data collected for the National Inpatient Sample(NIS).

-To examine demographics of patients undergoing primary anterior spine fusion (ASF), posterior spine fusion (PSF), and anterior/posterior spine fusion (APSF) of the noncervical spine.

-To assess the incidence of perioperative morbidity and mortality, and determine independent risk factors for in-hospital death.

The utilization of surgical fusion has been increasing dramatically. Despite this trend, a paucity of literature addressing perioperative outcomes exists.

-Subjects: National Inpatient Sample (1998~2006)
-Discharges with a procedure code for primary noncervical spine fusion were included in the sample.
-The prevalence of patient as well as health care system-related demographics were evaluated by procedure type (ASF, PSF, and APSF).
-Frequencies of procedure-related complications and in-hospital mortality were analyzed.
-Independent predictors for in-hospital mortality were determined.

-We identified 261,256 entries representing an estimated 1,273,228 hospitalizations for primary spine fusion.
ASF and APSF patients were significantly younger and had lower average comorbidity indeces than PSF patients. 
(age: 44.8 ± 0.08 and 44.22 ± 0.11 yrs vs 52.12 ± 0.04 yrs  / comorbidity: 0.30 ± 0.002 and 0.31 ± 0.004 vs 0.41 ± 0.002)

The incidence of complications:
- ASF: 18.68%
- PSF: 15.72%
- APSF: 23.81% (P < 0.0001)

^ comorbidity(동반질환)의 종류 별 분포율

In-hospital mortality rates: APSF were twice of PSF (0.51 ± 0.038 vs. 0.26 ± 0.012) (P < 

Risk factors for in-hospital mortality included the following: male gender, increasing age, and increasing comorbidity burden. Several comorbidities and complications independently increased the risk for perioperative death, as did underlying spinal pathology (APSF and ASF compared to PSF)



-Despite being performed in generally younger and healthier patients, APSF and ASF are associated with increased morbidity and mortality.