背景:先前的研究表明,成年宫颈畸形患者的死亡风险可能会增加,同时伴有虚弱或生理状态减弱。然而,这些研究往往受到随访时间的限制,需要进行更长期的研究来更好地评估ACD患者的时间变化和相关的死亡风险.
目的:评估合并症和生理负担减少的患者在接受成人宫颈畸形手术后,死亡风险是否会降低。
方法:回顾性回顾患者样本:两百九十例ACD患者结局指标:发病率和死亡率数据。
方法:包括术前(BL)和10年(10Y)数据的≥18岁ACD患者。患者被分层为过期和活着,以及在5Y之前或5Y和10Y之间按到期时间分组。通过均值比较分析评估组差异。Backstep逻辑回归确定了死亡率预测因子。Kaplan-Meier分析评估了过期患者的生存率。Logrank分析确定生存分布组的差异结果:共纳入66例患者(60.97±10.19年,48%为女性,28.03±7.28kg/m2)。在10Y内,12(ACD队列的18.2%)过期。在基线,患者的年龄相当,性别,BMI,和CCI总计平均(所有p>0.05)。此外,患者的BLHRQL具有可比性(均p>.05)。然而,在5Y和10Y之间过期的患者在2Y时表现出比较早过期的患者更高的BLEQ5D和mJOA评分(p<.021).此外,在BL时未出现CCI标记的患者在5Y-10Y随访窗前存活的可能性显著增加.手术,存活到5Y的患者之间观察到的唯一差异是进行截骨术,那些不需要它的人的生存期更长(p=0.003)。Logistic回归显示5Y前死亡的独立预测因子是BMI增加,增加了脆弱,和增加的水平融合(模型p<.001)。KM分析发现,Passias等人。脆弱,不虚弱患者的平均生存时间为170.56周,与虚弱患者的158.00相比(p=.949)。
结论:我们的研究表明,颈椎畸形手术后的长期生存可以通过基线手术因素来预测。通过优化BMI,脆弱状态,并在适当时最小化融合长度,外科医生可能能够进一步协助ACD患者提高术后生存能力。
BACKGROUND: Previous studies have demonstrated that adult cervical deformity patients may be at increased risk of death in conjunction with increased frailty or a weakened physiologic state. However, such studies have often been limited by follow-up duration, and longer-term studies are needed to better assess temporal changes in ACD patients and associated mortality risk.
OBJECTIVE: To assess if patients with decreased comorbidities and physiologic burden will be at lessened risk of death for a greater length of time after undergoing adult cervical deformity surgery.
METHODS: Retrospective review.
METHODS: Two hundred ninety ACD patients.
METHODS: Morbidity and mortality data.
METHODS: Operative ACD patients ≥18 years with pre-(BL) and 10-year (10Y) data were included. Patients were stratified as expired versus living, as well as temporally grouped by Expiration prior to 5Y or between 5Y and 10Y. Group differences were assessed via means comparison analysis. Backstep logistic regression identified mortality predictors. Kaplan-Meier analysis assessed survivorship of expired patients. Log rank analysis determined differences in survival distribution groups.
RESULTS: Sixty-six total patients were included (60.97±10.19 years, 48% female, 28.03±7.28 kg/m2). Within 10Y, 12 (18.2% of ACD cohort) expired. At baseline, patients were comparable in age, gender, BMI, and CCI total on average (all p>.05). Furthermore, patients were comparable in BL HRQLs (all p>.05). However, patients who expired between 5Y and 10Y demonstrated higher BL EQ5D and mJOA scores than their earlier expired counterparts at 2Y (p<.021). Furthermore, patients who presented with no CCI markers at BL were significantly more likely to survive until the 5Y-10Y follow-up window. Surgically, the only differences observed between patients who survived until 5Y was in undergoing osteotomy, with longer survival seen in those who did not require it (p=.003). Logistic regression revealed independent predictors of death prior to 5Y to be increased BMI, increased frailty, and increased levels fused (model p<.001). KM analysis found that by Passias et al frailty, not frail patients had mean survival time of 170.56 weeks, versus 158.00 in frail patients (p=.949).
CONCLUSIONS: Our study demonstrates that long-term survival after cervical deformity surgery may be predicted by baseline surgical factors. By optimizing BMI, frailty status, and minimizing fusion length when appropriate, surgeons may be able to further assist ACD patients in increasing their survivability postoperatively.