Tomoyuki Asada, Izzet Akosman, Francis C Lovecchio, Tejas Subramanian, Pratyush Shahi, Omri Maayan, Nishtha Singh, Kasra Araghi, Maximilian K Korsun, Olivia C Tuma, Anthony Pajak, Amy Z Lu, Eric Mai, Yeo Eun Kim, James E Dowdell, Evan D Sheha, Sravisht Iyer, Sheeraz A Qureshi
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Patients with subaxial cervical degenerative disorders were identified using ICD10 codes. Surgical procedures were defined with CPT code indicating ACDF (3-5 levels; ACDF3+), laminoplasty or laminectomy (3-5 levels), and posterior decompression and fusion (3-5 levels). Outcomes of interest including reoperation, airway complications, venous thromboembolism (VTE), surgical site infections (SSIs), and urinary tract infections (UTI) were compared by utilizing 1:1 propensity score matching between the 2 approaches.</p><p><strong>Results: </strong>We identified 568 patients who underwent ACDF3+ and 1590 patients who underwent PS. After propensity score matching, the cohorts with 568 patients each were well-balanced with a mean age of 70.9 years. All 17 patients with dialysis and 24 of 28 patients with congestive heart failure in the PS group before the matching were excluded through the matching process. Complications rates between ACDF3+ and PS group were similar in reoperation (2.1% vs. 3.3%; P=0.275), airway complications (0.9% vs. 0.9%; P=1.000), and VTE (1.1% vs. 0.7%; P=0.751), whereas the PS group had a higher rate of SSI (0.2% vs. 1.4%; P=0.045), UTI (1.1% vs. 3.0%; P=0.035), and LOS (2.5±6.1 vs, 4.3±3.9 d; P<0.001).</p><p><strong>Conclusions: </strong>Among elderly patients undergoing 3 or more levels of cervical spine surgery, there were comparable rates of 30-day life-threatening complications between the 2 approaches. However, potential selection bias exists, with surgeons possibly favoring posterior surgery for patients with higher-risk comorbidities.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Does Approach Matter? 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引用次数: 0
摘要
研究设计：回顾性队列研究。背景资料总结：由于危及生命的并发症风险，老年患者多节段颈椎狭窄的最佳手术入路存在争议。目的：比较≥3节段颈椎前后路手术老年患者危及生命的早期并发症发生率。方法：从美国外科医师学会国家手术质量改进计划数据库（NSQIP）中查询2016年至2021年期间接受ACDF或PS的65岁及以上患者的数据。使用ICD10代码识别下轴颈椎退行性疾病患者。用CPT代码定义手术步骤，ACDF(3-5级；ACDF3+)，椎板成形术或椎板切除术（3-5节段），后路减压融合（3-5节段）。结果包括再手术、气道并发症、静脉血栓栓塞（VTE）、手术部位感染（ssi）和尿路感染（UTI），通过两种方法之间1:1的倾向评分匹配进行比较。结果：我们确定了568例接受ACDF3+治疗的患者和1590例接受PS治疗的患者。在倾向评分匹配后，568例患者的队列平衡良好，平均年龄为70.9岁。配对前PS组17例透析患者和28例充血性心力衰竭患者中的24例通过配对过程被排除。ACDF3+组与PS组再手术并发症发生率相似(2.1% vs. 3.3%；P=0.275)，气道并发症(0.9% vs. 0.9%；P=1.000)和静脉血栓栓塞(1.1% vs. 0.7%；P=0.751)，而PS组的SSI发生率更高(0.2% vs. 1.4%；P=0.045), UTI (1.1% vs. 3.0%；P=0.035)， LOS(2.5±6.1 vs, 4.3±3.9 d；结论：在接受3级或以上颈椎手术的老年患者中，两种入路30天危及生命的并发症发生率相当。然而，存在潜在的选择偏倚，外科医生可能倾向于对高风险合并症患者进行后路手术。
Does Approach Matter? Comparison of Early Postoperative Life-threatening Complications in Elderly Patients With Multilevel Cervical Stenosis.
Study design: Retrospective cohort study.
Summary of background data: The optimal surgical approach for multilevel cervical stenosis in elderly patients is controversial because of the risk of life-threatening complication.
Objective: To compare life-threatening early complication rates between ≥3 levels anterior and posterior cervical surgery in elderly patients.
Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) were queried for patients 65 years or older who underwent ACDF or PS between 2016 and 2021. Patients with subaxial cervical degenerative disorders were identified using ICD10 codes. Surgical procedures were defined with CPT code indicating ACDF (3-5 levels; ACDF3+), laminoplasty or laminectomy (3-5 levels), and posterior decompression and fusion (3-5 levels). Outcomes of interest including reoperation, airway complications, venous thromboembolism (VTE), surgical site infections (SSIs), and urinary tract infections (UTI) were compared by utilizing 1:1 propensity score matching between the 2 approaches.
Results: We identified 568 patients who underwent ACDF3+ and 1590 patients who underwent PS. After propensity score matching, the cohorts with 568 patients each were well-balanced with a mean age of 70.9 years. All 17 patients with dialysis and 24 of 28 patients with congestive heart failure in the PS group before the matching were excluded through the matching process. Complications rates between ACDF3+ and PS group were similar in reoperation (2.1% vs. 3.3%; P=0.275), airway complications (0.9% vs. 0.9%; P=1.000), and VTE (1.1% vs. 0.7%; P=0.751), whereas the PS group had a higher rate of SSI (0.2% vs. 1.4%; P=0.045), UTI (1.1% vs. 3.0%; P=0.035), and LOS (2.5±6.1 vs, 4.3±3.9 d; P<0.001).
Conclusions: Among elderly patients undergoing 3 or more levels of cervical spine surgery, there were comparable rates of 30-day life-threatening complications between the 2 approaches. However, potential selection bias exists, with surgeons possibly favoring posterior surgery for patients with higher-risk comorbidities.
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.
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