Roland Duculan, Carol A Mancuso, Frank P Cammisa, Andrew A Sama, Alexander P Hughes, Darren R Lebl, Federico P Girardi
{"title":"早期和晚期再次腰椎手术在手术复杂性和残留疾病方面的差异。","authors":"Roland Duculan, Carol A Mancuso, Frank P Cammisa, Andrew A Sama, Alexander P Hughes, Darren R Lebl, Federico P Girardi","doi":"10.1097/BRS.0000000000005106","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review, single-institution cohort studies.</p><p><strong>Objective: </strong>To compare patients with earlier ( i.e. <1.5 yr) and later ( i.e . >1.5 yr) repeat lumbar surgery to patients with no repeat surgery according to clinical characteristics at index surgery.</p><p><strong>Background: </strong>Grouping patients as earlier or later repeat surgery may reveal different associations when compared with patients with no repeat surgery.</p><p><strong>Patients and methods: </strong>Patients undergoing index surgery for diverse conditions reported preoperative demographic/clinical variables, including comorbidity and depressive symptoms. Extent ( i.e . complexity) of surgery was assigned based on a valid index that included decompression, fusion, and instrumentation. Co-existing disease at nonoperated levels was ascertained from imaging reports. Postoperative records of all medical visits up to the time of this study (12 yr) were reviewed for repeat surgery. Patients were grouped as earlier (<1.5 yr) or later surgery (≥1.5 yr) and compared with patients with no repeat surgery in separate multivariable analyses.</p><p><strong>Results: </strong>Among 1334 patients (51% men, mean age 59), 82% did not have repeat surgery, 7% had earlier and 11% had later repeat surgery. Compared with no surgery, earlier surgery was associated with more comorbidity (OR: 1.7, CI: 1.1-2.6, P =0.02), positive depression screen (OR: 1.9, CI: 1.2-2.9, P =0.006), opioid use (OR: 1.8, CI: 1.2-2.8, P =0.008), and greater extent of index surgery (OR: 1.1, CI: 1.0-1.1, P =0.0009). Compared with no surgery, later surgery was associated with preindex lumbar surgery (OR: 1.9, CI: 1.3-2.8, P =0.0005) and disease at nonoperated levels at index surgery (OR: 1.6, CI: 1.0-2.4, P =0.05). Earlier surgeries were more likely to involve only the same vertebra as index surgery (51% vs. 16%) and later surgeries were more likely to involve only other levels (5% vs. 36%, P =0.01).</p><p><strong>Conclusions: </strong>Earlier and later repeat lumbar surgeries differed in complexity and residual disease compared with no repeat surgery. These findings have implications for patient counseling regarding short-term and long-term postoperative spine health.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E1-E6"},"PeriodicalIF":2.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Differences at Index Surgery in Operative Complexity and Residual Disease for Earlier and Later Repeat Lumbar Surgery.\",\"authors\":\"Roland Duculan, Carol A Mancuso, Frank P Cammisa, Andrew A Sama, Alexander P Hughes, Darren R Lebl, Federico P Girardi\",\"doi\":\"10.1097/BRS.0000000000005106\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective review, single-institution cohort studies.</p><p><strong>Objective: </strong>To compare patients with earlier ( i.e. <1.5 yr) and later ( i.e . >1.5 yr) repeat lumbar surgery to patients with no repeat surgery according to clinical characteristics at index surgery.</p><p><strong>Background: </strong>Grouping patients as earlier or later repeat surgery may reveal different associations when compared with patients with no repeat surgery.</p><p><strong>Patients and methods: </strong>Patients undergoing index surgery for diverse conditions reported preoperative demographic/clinical variables, including comorbidity and depressive symptoms. Extent ( i.e . complexity) of surgery was assigned based on a valid index that included decompression, fusion, and instrumentation. Co-existing disease at nonoperated levels was ascertained from imaging reports. Postoperative records of all medical visits up to the time of this study (12 yr) were reviewed for repeat surgery. Patients were grouped as earlier (<1.5 yr) or later surgery (≥1.5 yr) and compared with patients with no repeat surgery in separate multivariable analyses.</p><p><strong>Results: </strong>Among 1334 patients (51% men, mean age 59), 82% did not have repeat surgery, 7% had earlier and 11% had later repeat surgery. Compared with no surgery, earlier surgery was associated with more comorbidity (OR: 1.7, CI: 1.1-2.6, P =0.02), positive depression screen (OR: 1.9, CI: 1.2-2.9, P =0.006), opioid use (OR: 1.8, CI: 1.2-2.8, P =0.008), and greater extent of index surgery (OR: 1.1, CI: 1.0-1.1, P =0.0009). Compared with no surgery, later surgery was associated with preindex lumbar surgery (OR: 1.9, CI: 1.3-2.8, P =0.0005) and disease at nonoperated levels at index surgery (OR: 1.6, CI: 1.0-2.4, P =0.05). Earlier surgeries were more likely to involve only the same vertebra as index surgery (51% vs. 16%) and later surgeries were more likely to involve only other levels (5% vs. 36%, P =0.01).</p><p><strong>Conclusions: </strong>Earlier and later repeat lumbar surgeries differed in complexity and residual disease compared with no repeat surgery. These findings have implications for patient counseling regarding short-term and long-term postoperative spine health.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"E1-E6\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005106\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005106","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/25 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Differences at Index Surgery in Operative Complexity and Residual Disease for Earlier and Later Repeat Lumbar Surgery.
Study design: Retrospective review, single-institution cohort studies.
Objective: To compare patients with earlier ( i.e. <1.5 yr) and later ( i.e . >1.5 yr) repeat lumbar surgery to patients with no repeat surgery according to clinical characteristics at index surgery.
Background: Grouping patients as earlier or later repeat surgery may reveal different associations when compared with patients with no repeat surgery.
Patients and methods: Patients undergoing index surgery for diverse conditions reported preoperative demographic/clinical variables, including comorbidity and depressive symptoms. Extent ( i.e . complexity) of surgery was assigned based on a valid index that included decompression, fusion, and instrumentation. Co-existing disease at nonoperated levels was ascertained from imaging reports. Postoperative records of all medical visits up to the time of this study (12 yr) were reviewed for repeat surgery. Patients were grouped as earlier (<1.5 yr) or later surgery (≥1.5 yr) and compared with patients with no repeat surgery in separate multivariable analyses.
Results: Among 1334 patients (51% men, mean age 59), 82% did not have repeat surgery, 7% had earlier and 11% had later repeat surgery. Compared with no surgery, earlier surgery was associated with more comorbidity (OR: 1.7, CI: 1.1-2.6, P =0.02), positive depression screen (OR: 1.9, CI: 1.2-2.9, P =0.006), opioid use (OR: 1.8, CI: 1.2-2.8, P =0.008), and greater extent of index surgery (OR: 1.1, CI: 1.0-1.1, P =0.0009). Compared with no surgery, later surgery was associated with preindex lumbar surgery (OR: 1.9, CI: 1.3-2.8, P =0.0005) and disease at nonoperated levels at index surgery (OR: 1.6, CI: 1.0-2.4, P =0.05). Earlier surgeries were more likely to involve only the same vertebra as index surgery (51% vs. 16%) and later surgeries were more likely to involve only other levels (5% vs. 36%, P =0.01).
Conclusions: Earlier and later repeat lumbar surgeries differed in complexity and residual disease compared with no repeat surgery. These findings have implications for patient counseling regarding short-term and long-term postoperative spine health.
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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.
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