경추체 제거술 후의 수술결과와 위관절증에 대한 흡연의 영향 The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy

Brief review

JNS에서 10월호에 출판된 재밌는 논문 입니다.

결론부터 말하자면, 경추체 제거술 후의 수술결과와 합병증(pseudarthrosis)에 흡연여부가 유의하게 영햐을 미친다는 내용 입니다.

흡연여부에 따라 피험자를 비흡연자/ 끊은지 최소 1년이상된 자/ 흡연자  의 3그룹으로 나누었고, 이 피험자들의 30일이내 합병증 발병, 출혈량, 재원일수 등의 항목을 조사하였습니다.

결과적으로 흡연여부는 더 높은 합병증 발병률, 더 긴 재원일수에 영향을 미치는 risk factor로 밝혀졌으며, 감염 및 pseudarthrosis등의 합병증 발병에 특히 영향을 미친다고 합니다.

흡연의 해로움을 객관적 데이터로 보여준 논문입니다.

*Title: The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy.

경추체 제거술 후의 수술결과와 위관절증에 대한 흡연의 영향

*Authors: Lau D, Chou D, Ziewacz JE, Mummaneni PV

*Bibliography: J Neurosurg Spine. 2014 Oct;21(4):547-58.

Object

Smoking is one of the leading causes of preventable morbidity and death in the US and has been associated with perioperative complications.

-To examined the effects of smoking on perioperative outcomes and pseudarthrosis rates following anterior cervical corpectomy.

Methods

▶Subjects: adult patients underwent anterior cervical corpectomy (2006~2011)

▶Grouping:

1) nonsmokers

2) quitters (quit for at least 1yr)

3) current smokers

▶Statistical analysis: using multivariate analysis

(To define the relationship between smoking and blood loss, 30-day complications, length of hospital stay, and pseudarthrosis)

Results

▶Total 160 patients were included in the study.

(nonsmokers 49.4%, quitters 25.6%, current smokers 25.0%)

▶30-day complication rate: 20.0% (pseudarthrosis: 7.6%)

▶Mean blood loss: 368.3ml

▶Mean length of stay: 6.5days.

-Current smoking status was significantly associated with higher complication rates (p < 0.001) and longer lengths of stay (p < 0.001).

-Current smoking status remained an independent risk factor for both outcomes.

                                     

The complications that were experienced in current smokers were mostly infections (76.5%).

(Significantly greater than in nonsmokers and quitters (p = 0.013))

-Current smoking status was also an independent risk factor for pseudarthrosis at 1-year follow-up (p = 0.012).

Conclusions

Smoking is independently associated with higher perioperative complications (especially infectious complications), longer lengths of stay, and higher rates of pseudarthrosis in patients undergoing anterior cervical corpectomy. 

Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases

Brief review

이 논문은 퇴행성 척추질환으로 후방경유 요추 유합술을 시행한 817명의 환자 데이터를 리뷰하여 감염에 영향을 끼칠 수 있는 요소를 밝힌 논문 입니다.

감염과 연관된 요소를 밝히기 위해 ‘단계적 다변량 비례 위험도 회기 분석법’을 이용하였습니다.

결과적으로, 연령의 증가와 당뇨병, 비만, 이전의 척추수술 경험 및 재원일수의 증가 등이 후방 경유 요추 유합술 후의 감염의 위험성을 증가시킬 수 있는 요인으로 드러났습니다.

*Title: Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases

퇴행성 척추질환으로 후방 경유 요추 유합술을 시행한 817명 환자들의 감염 위험성

*Authors: Kaisorn L. Chaichana, M.D., Mohamad Bydon, M.D., David R. Santiago-Dieppa, M.D., Lee Hwang, M.D., Gregory McLoughlin, M.D., Daniel M. Sciubba, M.D., Jean-Paul Wolinsky, M.D., Ali Bydon, M.D., Ziya L. Gokaslan, M.D., and Timothy Witham, M.D.Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

*Bibliography: J Neurosurg Spine 20:45–52, 2014

Summary of Background

Posterior lumbar spinal fusion for degenerative spine disease is a common procedure, and its use is increasing annually. The rate of infection, as well as the factors associated with an increased risk of infection, remains unclear for this patient population. A better understanding of these features may help guide treatment strategies aimed at minimizing infection for this relatively common procedure.

Object

To ascertain the incidence of postoperative spinal infections and identify factors associated with postoperative spinal infections.

Methods

▶Subject: patients underwent instrumented posterior lumbar fusion for degenerative spine disease (1993~2010)

“Stepwise multivariate proportional hazards regression analysis” was used to identify factors associated with infection.

Variables with p < 0.05 were considered statistically significant.

Results

▶Total subjects: 817 patients underwent lumbar fusion

▶Infection patients: 37(4.5%)

-21 (57%) required operative intervention but only 3 (8%) required instrumentation removal as part of their infection management.

▶The factors independently associated with an increased risk of infection.

1) increasing age (RR 1.004 [95% CI 1.001–1.009], p = 0.049)

2) diabetes (RR 5.583 [95% CI 1.322–19.737], p = 0.02)

3) obesity (RR 6.216 [95% CI 1.832–9.338], p = 0.005)

4) previous spine surgery (RR 2.994 [95% CI 1.263–9.346], p = 0.009)

5) increasing duration of hospital stay (RR 1.155 [95% CI 1.076–1.230], p = 0.003)

Conclusions

-older age, diabetes, obesity, prior spine surgery, and length of hospital stay: independently associated with an increased risk of infection in lumbar fusion for degenerative spine disease

-The overwhelming majority of these patients were treated effectively without hardware removal.

Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases.

Brief review

이 논문은 퇴행성 척추질환 때문에 후방경유 요추 유합술을 받은 817명의 환자에게 나타난 감염률과 감염에 영향을 끼치는 요소들을 연구한 논문 입니다.

후향적으로 환자의 데이터를 검토하여 감염률을 조사했고, 단계적 다변량 비례 위험 회귀분석법을 통하여 요추감염과 연관성이 있는 요소들을 알아냈습니다.

연구대상인 817명의 환자에 대해서는 감염률이 4.5%로 나타났고,  나이, 당뇨지수, 비만도, 이전에 척추수술을 시행했는지의 여부, 재원기간 등의 요소들이 감염에 영향을 끼치는 것으로 나타났습니다.

*Title: Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases.

퇴행성 척추질환으로 후방경유 요추 유합술을 시행한 817명의 사례에 대한 감염의 위험성

*Author: Kaisorn L. Chaichana, Mohamad Bydon, David R. Santiago-Dieppa, Lee Hwang, Gregory McLoughlin, Daniel M. Sciubb a, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan, Timothy Witham

*Bibliography: J Neurosurg Spine. 2013 Nov 8. [Epub aheadof print]

Object

The rate and factors of infection risk remains unclear for Posterior lumbar spinal fusion (for degenerative spine disease)

Purpose: To ascertain the incidence and factors of postoperative spinal infections.

Methods

▶Period: 1993 ~ 2010

▶Subject: 817 patients who underwent posterior lumbar fusion for degenerative disease.

-Retrospectively data reviewed.

-To identify the infection factors, using Stepwise multivariate proportional hazards regression analysis.

Results

1. Infection rate: 4.5%

(37 patients out of 817 patients developed postoperative spine infection at a median of 0.6 months (IQR 0.3-0.9) ).

2. Infection factors

1. age (RR 1.004 [95% CI 1.001-1.009], p = 0.049)

2. diabetes (RR 5.583 [95% CI 1.322-19.737], p = 0.02)

3. obesity (RR 6.216 [95% CI 1.832-9.338], p = 0.005)

4. previous spine surgery (RR 2.994 [95% CI 1.263-9.346], p = 0.009)

5. duration of hospital stay (RR 1.155 [95% CI 1.076-1.230], p = 0.003).

Conclusions

-Several factors were associated with an risk of infection among patients underwent lumbar fusion for degenerative disease. (factors: older age, diabetes, obesity, prior spine surgery, and length of hospital stay)