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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.



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.