Abstract：
Thoracic costotransversectomies are among the most invasive spinal procedures performed and are associated with unanticipated medical and surgical complications. Few studies have specifically assessed medical and surgical complications after a thoracic corpectomy via a costotransversectomy approach (TCT) or compared complications between different diagnoses. The purpose of this study was to describe the differences in operative characteristics and rates of 90-day surgical and medical complications in patients undergoing TCTs based on underlying diagnosis.
A retrospective chart review of 123 consecutive patients who underwent TCTs at a single academic referral center over a 10-year period was conducted. Surgical indication, corpectomy levels, intraoperative dural tears, pleural injuries, neurological injuries, 90-day mortality, 90-day reoperations, and hospital-based medical complications were evaluated.
One hundred twenty-three patients underwent a TCT, including 35 for infection, 42 for malignancy, 23 for trauma, and 23 for deformity. Fifty-nine patients (48.0%) had at least one medical or 90-day operative complication, with 22 patients (17.9%) having two or more complications. Patients with a diagnosis of infection were more likely to undergo two-level corpectomies (80% vs 26.1%, p < 0.0005). Patients with a diagnosis of malignancy had significantly higher 90-day mortality (19.0% vs 4.9%, p = 0.022) and were more likely to undergo three-level corpectomies (9.5% vs 3.7%, p = 0.002) and upper thoracic (T1-4) corpectomies (37.9% vs 12.4%, p = 0.001), and sustain a pleural injury (14.3% vs 2.5%, p = 0.019). Ninety-day reoperation rates (p = 0.970), postoperative ventilator days (p = 0.224), intensive care unit stays (p = 0.350), hospital lengths of stay (p = 0.094), neurological injuries (p = 0.338), and dural tears (p = 0.794) did not significantly vary between the different groups.
Nearly half of the patients undergoing a TCT will experience an unanticipated short-term complication related to the procedure. Short-term complications may vary with the underlying patient diagnosis.
A retrospective chart review of 123 consecutive patients who underwent TCTs at a single academic referral center over a 10-year period was conducted. Surgical indication, corpectomy levels, intraoperative dural tears, pleural injuries, neurological injuries, 90-day mortality, 90-day reoperations, and hospital-based medical complications were evaluated.
One hundred twenty-three patients underwent a TCT, including 35 for infection, 42 for malignancy, 23 for trauma, and 23 for deformity. Fifty-nine patients (48.0%) had at least one medical or 90-day operative complication, with 22 patients (17.9%) having two or more complications. Patients with a diagnosis of infection were more likely to undergo two-level corpectomies (80% vs 26.1%, p < 0.0005). Patients with a diagnosis of malignancy had significantly higher 90-day mortality (19.0% vs 4.9%, p = 0.022) and were more likely to undergo three-level corpectomies (9.5% vs 3.7%, p = 0.002) and upper thoracic (T1-4) corpectomies (37.9% vs 12.4%, p = 0.001), and sustain a pleural injury (14.3% vs 2.5%, p = 0.019). Ninety-day reoperation rates (p = 0.970), postoperative ventilator days (p = 0.224), intensive care unit stays (p = 0.350), hospital lengths of stay (p = 0.094), neurological injuries (p = 0.338), and dural tears (p = 0.794) did not significantly vary between the different groups.
Nearly half of the patients undergoing a TCT will experience an unanticipated short-term complication related to the procedure. Short-term complications may vary with the underlying patient diagnosis.
摘要：
目的：胸部肋片切除是最有侵入性的脊柱手术之一，与意料之外的内科和外科并发症相关。很少有研究专门评估通过肋片切除（TCT）进行胸椎切除术后的内科和外科并发症，或比较不同诊断之间的并发症。这项研究的目的是描述基于潜在诊断的TCT患者的手术特征以及90天手术和内科并发症发生率的差异。
方法：对在一个学术转诊中心进行10年的123例连续TCTs患者进行回顾性分析。手术适应症,全身切除术水平，术中硬脑膜撕裂，胸膜损伤,神经损伤,90天死亡率，90天的再手术,和以医院为基础的医疗并发症进行了评估。
结果：一百二十三例患者接受了TCT，包括35例感染，42为恶性肿瘤，23号外伤，和23畸形。59名患者（48.0％）至少有一次内科或90天手术并发症，22例患者（17.9%）有两个或两个以上的并发症。诊断为感染的患者更有可能进行两级皮质切除术（80％vs26.1％，p<0.0005)。诊断为恶性肿瘤的患者的90天死亡率明显更高（19.0％vs4.9％，p=0.022），并且更有可能进行三级皮质切除术（9.5％vs3.7％，p=0.002）和上胸部（T1-4）皮质切除术（37.9％vs12.4％，p=0.001),并维持胸膜损伤(14.3%vs2.5%，p=0.019)。90天再手术率（p=0.970），术后呼吸机天数（p=0.224），重症监护病房住院（p=0.350），住院时间（p=0.094），神经损伤（p=0.338），硬脑膜撕裂（p=0.794）在不同组之间没有显着差异。
结论：将近一半接受TCT的患者会经历与手术相关的意外短期并发症。短期并发症可能因患者的潜在诊断而异。
方法：对在一个学术转诊中心进行10年的123例连续TCTs患者进行回顾性分析。手术适应症,全身切除术水平，术中硬脑膜撕裂，胸膜损伤,神经损伤,90天死亡率，90天的再手术,和以医院为基础的医疗并发症进行了评估。
结果：一百二十三例患者接受了TCT，包括35例感染，42为恶性肿瘤，23号外伤，和23畸形。59名患者（48.0％）至少有一次内科或90天手术并发症，22例患者（17.9%）有两个或两个以上的并发症。诊断为感染的患者更有可能进行两级皮质切除术（80％vs26.1％，p<0.0005)。诊断为恶性肿瘤的患者的90天死亡率明显更高（19.0％vs4.9％，p=0.022），并且更有可能进行三级皮质切除术（9.5％vs3.7％，p=0.002）和上胸部（T1-4）皮质切除术（37.9％vs12.4％，p=0.001),并维持胸膜损伤(14.3%vs2.5%，p=0.019)。90天再手术率（p=0.970），术后呼吸机天数（p=0.224），重症监护病房住院（p=0.350），住院时间（p=0.094），神经损伤（p=0.338），硬脑膜撕裂（p=0.794）在不同组之间没有显着差异。
结论：将近一半接受TCT的患者会经历与手术相关的意外短期并发症。短期并发症可能因患者的潜在诊断而异。
