The Utility of the Surgical Apgar Score in Assessing the Risk of Perioperative Complications Following Spinal Fusion Surgery for Pediatric Patients With Scoliosis and Cerebral Palsy.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-01-15 Epub Date: 2024-07-17 DOI:10.1097/BRS.0000000000005098

Kensuke Shinohara, Tracey P Bryan, Carrie E Bartley, Michael P Kelly, Vidyadhar V Upasani, Peter O Newton

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引用次数: 0

Abstract

Study design: Cohort study.

Objective: Validate the Surgical Apgar Score (SAS) as a means of predicting perioperative major complications occurring within 30 days after scoliosis surgery in pediatric patients with cerebral palsy (CP).

Summary of background data: A patient's SAS, which is composed of three commonly recorded intraoperative variables, predicts postoperative complications after various types of spine surgery. This has not; however, been studied in pediatric patients with scoliosis and CP, a population that experiences a high incidence of complications after corrective spinal surgery.

Methods: Pediatric CP patients who underwent spinal correction surgery were included in this study. Patient background, surgical variables, and perioperative complications occurring within 30 days after surgery were collected. Patients were divided into 4 groups based on their SAS: SAS 0 to 4, SAS 5 to 6, SAS 7 to 8, and SAS 9 to 10. The incidences of perioperative complications for each group were compared using a receiver operating characteristic analysis. The area under the curve (AUC) is reported.

Results: A total of 111 patients met the inclusion criteria. There were no death cases. There were 44 (39.6%) perioperative major complications in 37 (33.3%) patients that occurred within 30 days after spine surgery. The most frequent perioperative complications were pulmonary issues (13.5%). The incidence of perioperative major complication in each SAS group was as follows: SAS 0 to 4; 51.6%, SAS 5 to 6; 30.2%, SAS 7 to 8; 18.5%, SAS 9 to 10; 0/0. When the SAS 7 to 8 group was set as the reference, there was no significant difference compared to SAS 5 to 6 ( P =0.34), while the incidence rate was significantly increased in SAS 0 to 4 ( P =0.02). The AUC was 0.65 (95% CI: 0.54-0.75).

Conclusions: Overall, there were 37 (33.3%) patients with CP who had a major complication within 30 days after spinal surgery. Lower SAS, with the 0 to 4 group being the cutoff, were associated with significantly higher complication rates than higher SAS groups.

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手术阿普加评分在评估脊柱侧弯和脑瘫儿科患者脊柱融合手术后围手术期并发症风险中的实用性。

研究设计队列研究：验证手术阿普加评分（SAS）作为预测脑瘫（CP）儿科患者脊柱侧弯手术后 30 天内发生的围手术期主要并发症的一种方法：患者的 SAS（由术中通常记录的三个变量组成）可预测各类脊柱手术后的并发症。然而，对脊柱侧弯和脊柱裂的小儿患者还没有进行过这方面的研究，而小儿脊柱侧弯和脊柱裂患者是脊柱矫正手术后并发症的高发人群：本研究纳入了接受脊柱矫正手术的小儿脊柱侧弯患者。收集了患者背景、手术变量以及术后 30 天内发生的围手术期并发症。根据 SAS 将患者分为 4 组：SAS 0-4、SAS 5-6、SAS 7-8、SAS 9-10。各组围手术期并发症的发生率采用接收器操作特征分析法进行比较。报告了曲线下面积（AUC）：共有 111 名患者符合纳入标准。没有死亡病例。37名患者（33.3%）在脊柱手术后30天内出现了44例（39.6%）围术期主要并发症。最常见的围手术期并发症是肺部问题（13.5%）。各 SAS 组围手术期主要并发症的发生率如下：以 SAS 7-8 组为参照，与 SAS 5-6 组相比无显著差异（P=0.34），而 SAS 0-4 组的发生率显著增加（P=0.02）。AUC为0.65（95% 置信区间：0.54-0.75）：总体而言，有 37 名（33.3%）CP 患者在脊柱手术后 30 天内出现了主要并发症。以0-4组为分界点的较低SAS组的并发症发生率明显高于较高SAS组。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.