单层腰椎融合术前接受减肥手术的患者10年内全因复发的风险未见增加。

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-08-12 DOI:10.1097/BSD.0000000000001669
Emile-Victor Kuyl, Arnav Gupta, Philip M Parel, Theodore Quan, Tushar Ch Patel, Addisu Mesfin
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引用次数: 0

摘要

研究设计回顾性队列研究:本研究旨在评估与普通人群和病态肥胖患者相比,曾接受减肥手术(BS)是否与腰椎融合术的 10 年手术并发症和翻修率较高有关:背景:肥胖会加速脊柱退行性病变的进程,通常需要进行腰椎融合术来改善功能。在腰椎病例中,BS 可用于减轻体重,但其对融合术结果的影响仍不明确。关于腰椎融合术前 BS 的现有文献得出了相互矛盾的结果,对长期脊柱并发症的调查也很有限:利用 PearlDiver 数据库,我们对接受选择性初级单层腰椎融合术的患者进行了研究,并根据患者之前的 BS 进行了分类。倾向得分匹配从(1)无 BS 史的普通人群和(2)无 BS 史的病态肥胖患者中创建队列。我们使用 Kaplan-Meier 和 Cox 比例危险模型比较了全因翻修和特定翻修适应症的 10 年累积发病率和危险比 (HR):与普通人群中的匹配对照组相比,接受过 BS 的患者在腰椎融合术后 10 年内进行减压椎板切除术和冲洗清创术(I&D)的累积发生率和风险更高[减压椎板切除术:HR = 1.32;I&D:HR = 1.35]。与病态肥胖人群中的匹配对照组相比,接受 BS 的患者发生邻近节段疾病(HR = 0.31)和 I&D (HR = 0.64)的几率较低。然而,与来自普通人群或病态肥胖患者的匹配或非匹配对照组相比,接受过 BS 的患者 10 年内全因翻修的风险并没有增加(P > 0.05):结论:与普通人群或病态肥胖患者相比,接受过 BS 的腰椎融合术患者 10 年内全因翻修的风险并没有增加。然而,与未接受 BS 的病态肥胖患者相比,接受过 BS 的患者 10 年内发生 I&D 的风险较低。我们的研究表明,接受 BS 的患者与这些对照组的长期手术并发症发生率相当,与病态肥胖患者相比,感染性并发症的风险相应降低。虽然 BS 可以解决内科合并症,但它对腰椎融合术翻修的长期效果影响有限。
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No Increased Risk of All-cause Revision up to 10 Years in Patients Who Underwent Bariatric Surgery Before Single-level Lumbar Fusion.

Study design: Retrospective cohort study.

Objective: This study aimed to assess whether prior bariatric surgery (BS) is associated with higher 10-year surgical complication and revision rates in lumbar spine fusion compared with the general population and morbidly obese patients.

Background: Obesity accelerates degenerative spine processes, often necessitating lumbar fusion for functional improvement. BS is explored for weight loss in lumbar spine cases, but its impact on fusion outcomes remains unclear. Existing literature on BS before lumbar fusion yields conflicting results, with a limited investigation into long-term spine complications.

Methods: Utilizing the PearlDiver database, we examined patients undergoing elective primary single-level lumbar fusion, categorizing them by prior BS. Propensity score matching created cohorts from (1) the general population without BS history and (2) morbidly obese patients without BS history. Using Kaplan-Meier and Cox proportional hazard modeling, we compared 10-year cumulative incidence rates and hazard ratios (HRs) for all-cause revision and specific revision indications.

Results: Patients who underwent BS exhibited a higher cumulative incidence and risk of decompressive laminectomy and irrigation & debridement (I&D) within 10 years postlumbar fusion compared with matched controls from the general population [decompressive laminectomy: HR = 1.32; I&D: HR = 1.35]. Compared with matched controls from a morbidly obese population, patients who underwent BS were associated with lower rates of adjacent segment disease (HR = 0.31) and I&D (HR = 0.64). However, the risk of all-cause revision within 10 years did not increase for patients who underwent BS compared with matched or unmatched controls from the general population or morbidly obese patients (P > 0.05).

Conclusions: Prior BS did not elevate the 10-year all-cause revision risk in lumbar fusion compared with the general population or morbidly obese patients. However, patients who underwent BS were associated with a lower 10-year risk of I&D when compared with morbidly obese patients without BS. Our study indicates comparable long-term surgical complication rates between patients who underwent BS and these control groups, with an associated reduction in risk of infectious complications when compared with morbidly obese patients. Although BS may address medical comorbidities, its impact on long-term lumbar fusion revision outcomes is limited.

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来源期刊
Clinical Spine Surgery
Clinical Spine Surgery Medicine-Surgery
CiteScore
3.00
自引率
5.30%
发文量
236
期刊介绍: Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
期刊最新文献
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