Iyan Younus, Omar Zakieh, Hani Chanbour, Harsh Jain, Ranbir Ahluwalia, Campbell Liles, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman
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引用次数: 0
Abstract
Background and objectives: In a cohort of patients undergoing Adult Spinal Deformity (ASD) surgery, we sought to (1) report the rate of and reason for reoperation within 6 months of the index surgery and (2) determine the association between early reoperation and 2-year patient-reported outcome measures (PROMs).
Methods: A single-institution, retrospective cohort study was performed for patients undergoing ASD surgery from 2009 to 2021. The primary outcomes included early reoperations within 6 months and reason for reoperation, including proximal junctional kyphosis/failure (PJK/F), distal junctional kyphosis, pseudarthrosis/rod fracture, and implant failure. Secondary outcomes included all mechanical complications requiring reoperation beyond 6 months and PROMs. Descriptive statistics and multivariable logistic regression were performed.
Results: Of 238 patients undergoing ASD surgery, 19 (8%) underwent early reoperation within 6 months primarily for PJK/F (42%), distal junctional kyphosis (11%), implant failure (11%), and pseudarthrosis (11%). Early reoperation was significantly more likely in patients with 2+ comorbidities (63.2% vs 38.6%, P = .038) but did not predict future reoperation beyond 6 months (47.4% vs 58.0%; P = .159). At 2 years, patients with early reoperation had worse PROMs: higher Oswestry Disability Index (ODI) (53.9 vs 33.8, P = .001), Numeric Rating Scales for back pain (NRS-BP) (6.8 vs 4.7, P = .019), Numeric Rating Scales for leg pain (NRS-LP) (5.7 vs 2.8, P = .004) and lower EuroQoL Group questionnaire (EQ-5D) (0.50 vs 0.70, P = .003). There was less improvement in ODI (-16.6 vs -2.0, P = .025) and EQ-5D (0.0 vs 0.2, P = .038), with no significant change in NRS-BP (P = .051) and NRS-LP (P = .115). Early reoperation was linked to decreased odds of ODI improvement (OR 14.41, P = .028).
Conclusion: Reoperation within 6 months after ASD surgery occurred in 8% of patients at mean 85.5 days, primarily because of PJK/F (42%). Early reoperations did not significantly increase the rate of subsequent reoperations beyond 6 months. Patients with early reoperation within 6 months had worse ODI, NRS-BP, and NRS-LP and less improvement in ODI and EQ-5D, but no difference in change for NRS-BP and NRS-LP. Early reoperation significantly decreased odds of ODI improvement.
背景和目的：在一组接受成人脊柱畸形（ASD）手术的患者中，我们试图(1)报告指数手术后6个月内再手术的发生率和原因，(2)确定早期再手术与2年患者报告的结果测量（PROMs）之间的关系。方法：对2009年至2021年接受ASD手术的患者进行单机构、回顾性队列研究。主要结果包括6个月内的早期再手术和再手术的原因，包括近端关节后凸/失败（PJK/F）、远端关节后凸、假关节/棒骨折和植入物失败。次要结果包括6个月以上需要再次手术的所有机械并发症和prom。进行描述性统计和多变量logistic回归。结果：在238例接受ASD手术的患者中，19例（8%）在6个月内进行了早期再手术，主要原因是PJK/F（42%）、远端关节后凸（11%）、植入物失败（11%）和假关节（11%）。2+合并症患者早期再手术的可能性显著增加（63.2% vs 38.6%, P = 0.038），但不能预测未来6个月以上的再手术(47.4% vs 58.0%；P = .159)。2年后，早期再手术患者的PROMs更差：Oswestry残疾指数（ODI）更高（53.9 vs 33.8, P = .001），背部疼痛数值评定量表（NRS-BP） （6.8 vs 4.7, P = .019），腿部疼痛数值评定量表（NRS-LP） （5.7 vs 2.8, P = .004）和EuroQoL Group问卷（EQ-5D）较低（0.50 vs 0.70, P = .003）。ODI （-16.6 vs -2.0, P = 0.025）和EQ-5D （0.0 vs 0.2, P = 0.038）改善较少，NRS-BP （P = 0.051）和NRS-LP （P = 0.115）无显著变化。早期再手术与ODI改善的几率降低相关（OR 14.41, P = 0.028）。结论：ASD术后6个月内再次手术发生率为8%，平均为85.5天，主要原因是PJK/F（42%）。早期再手术对术后6个月的再手术率无显著影响。6个月内早期再手术患者ODI、NRS-BP和NRS-LP均较差，ODI和EQ-5D改善较少，但NRS-BP和NRS-LP变化无差异。早期再手术显著降低ODI改善的几率。
期刊介绍：
Operative Neurosurgery is a bi-monthly, unique publication focusing exclusively on surgical technique and devices, providing practical, skill-enhancing guidance to its readers. Complementing the clinical and research studies published in Neurosurgery, Operative Neurosurgery brings the reader technical material that highlights operative procedures, anatomy, instrumentation, devices, and technology. Operative Neurosurgery is the practical resource for cutting-edge material that brings the surgeon the most up to date literature on operative practice and technique
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