介绍由于各种潜在的病理,腰椎椎间融合已经被用于缓解背痛并提高稳定性。前路椎间融合和后路椎间融合是经典比较的两种主要方法。为了比较这两种脊柱方法,进行了大型回顾性国家数据库审查,以比较和预测术后30天的结局;然而,他们有相互矛盾的发现。肥胖,定义为体重指数(BMI)超过30kg/m2,也可能有助于脊柱病理的程度,并与术后并发症的发生率增加有关。肥胖患者的并发症发生率尚未使用大型国家数据库进行彻底调查。我们目前的调查旨在使用美国外科医生协会国家外科质量改善计划(ACS-NSQIP)数据库进行比较。本研究的目的是利用全国范围的前瞻性数据库来确定肥胖患者腰椎后路和前路融合术后结果的短期差异,并将这些发现与先前在普通人群中的研究联系起来。方法对2015年至2019年ACS-NSQIP数据库中9,021例患者资料进行回顾性队列分析,通过前或后手术入路进行单层融合。该数据库捕获了150多个关于单个患者病例的临床变量,包括人口统计数据,术前危险因素和实验室值,术中数据,和显著事件直到术后30天。所有结局指标均纳入本分析,并特别注意深静脉血栓形成(DVT)和肺栓塞(PE)的发生率。延长住院时间(LOS),再操作,和操作时间。结果多变量分析控制年龄,BMI,性别,种族,功能状态,美国麻醉医师协会(ASA)班,和选定的合并症(P<0.05)表明,前入路是所有重要结局的独立预测因素,除了住院时间延长。与后路相比,前路手术总时间较短(B=-13.257,95%置信区间(CI)[-17.522,-8.992],P<0.001),深静脉血栓形成的几率更高(比值比(OR)=2.210,95%CI[1.211,4.033],P=0.010),肺栓塞的几率更高(OR=2.679,95%CI[1.311,5.477],P=0.007),并且可以防止计划外的再次手术(OR=0.702,95%CI[0.548,0.898],P=0.005)。结论肥胖人群在接受脊柱手术的人群中构成了大量且不断增长的人群,因此,调查差异是恰当的,优势,和该组腰椎融合方法的缺点。虽然前路入路可以保护较长的手术时间和计划外的再次手术,当考虑到DVT和PE风险增加时,这种获益在临床上可能并不显著.鉴于该数据集的短期性质以及大型去识别回顾性数据库研究固有的局限性,这些发现被谨慎地解释.为了进一步阐明这些细微差别,有必要进行长期随访研究,以混淆变量和以脊柱为中心的结果。
Introduction Lumbar spine interbody fusions have been performed to relieve back pain and improve stability due to various underlying pathologies. Anterior interbody fusion and posterior interbody fusion approaches are two main approaches that are classically compared. In an attempt to compare these two approaches to the spine, large retrospective national database reviews have been performed to compare and predict 30-day postoperative outcomes; however, they have conflicting findings. Obesity, defined as having a body mass index (BMI) over 30 kg/m2, may also contribute to the extent of spine pathology and is associated with increased rates of postoperative complications. Complication rates in patients who are obese have yet to be thoroughly investigated using a large national database. Our present investigation aims to make this comparison using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The goal of the present
study is to utilize a nationwide prospective database to determine short-term differences in postoperative outcomes between posterior and anterior lumbar fusion in patients with obesity and relate these findings to previous studies in the general population. Methods A retrospective cohort analysis was conducted on 9,021 patient data from the ACS-NSQIP database from 2015 to 2019 who underwent an elective, single-level fusion via anterior or posterior surgical approach. This database captures over 150 clinical variables on individual patient cases, including demographic data, preoperative risk factors and laboratory values, intraoperative data, and significant events up to postoperative day 30. All outcome measures were included in this analysis with special attention to rates of deep venous thrombosis (DVT) and pulmonary embolism (PE), prolonged length of stay (LOS), reoperation, and operation time. Results Multivariable analysis controlling for age, BMI, sex, race, functional status, American Society of Anesthesiologists (ASA) class, and selected comorbidities with P < 0.05 demonstrated that the anterior approach was an independent predictor for all significant outcomes except prolonged length of stay. Compared to the posterior approach, the anterior approach had a shorter total operation time (B = -13.257, 95% confidence interval (CI) [-17.522, -8.992], P < 0.001), higher odds of deep vein thrombosis (odds ratio (OR) = 2.210, 95% CI [1.211, 4.033], P= 0.010), and higher odds of pulmonary embolism (OR = 2.679, 95% CI [1.311, 5.477], P = 0.007) and was protective against unplanned reoperation (OR = 0.702, 95% CI [0.548, 0.898], P = 0.005). Conclusions The obese population makes up a large and growing demographic of those undergoing spine surgery, and as such, it is pertinent to investigate the differences, advantages, and disadvantages of lumbar fusion approaches in this group. While anterior approaches may be protective of longer operation time and unplanned reoperation, this benefit may not be clinically significant when considering an increased risk of DVT and PE. Given the short-term nature of this dataset and the limitations inherent in large de-identified retrospective database studies, these findings are interpreted with caution. Longer-term follow-up studies accounting for confounding variables with spine-centered outcomes will be necessary to further elucidate these nuances.