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.
STUDY DESIGN
Analysis of population-based national hospital discharge
data collected for the National Inpatient Sample(NIS).
OBJECTIVE
-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.
SUMMARY OF
BACKGROUND DATA
The utilization of surgical fusion has been increasing
dramatically. Despite this trend, a paucity of literature addressing
perioperative outcomes exists.
METHODS
-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.
RESULTS
-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 <
0.0001)
▶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)
CONCLUSION
-Despite being performed in generally younger and
healthier patients, APSF and ASF are
associated with increased morbidity and mortality.
