背景:尽管后路减压并融合(PDF)对治疗胸椎脊髓病有效,手术治疗有很高的各种并发症的风险。目前尚无有关胸椎纵韧带骨化(T-OPLL)和胸椎黄韧带骨化(T-OLF)的围手术期并发症的信息。我们评估了接受PDF的患者的T-OPLL和T-OLF之间的围手术期并发症发生率和成本。
方法:在日本全国住院数据库中检测到2012年至2018年接受T-OPLL和T-OLFPDF的患者。根据患者特征和术前合并症,在T-OPLL和T-OLF之间进行一对一倾向评分匹配。我们检查了全身和局部并发症发生率,再手术率,住院时间,成本,排放目的地,匹配后的死亡率。
结果:在总共2,660名患者中,匹配后纳入828对T-OPLL和T-OLF患者。T-OPLL组和OLF组的全身并发症发生率无显著差异。然而,T-OPLL组的局部并发症发生率高于T-OLF组(11.4%vs.7.7%P=0.012)。T-OPLL组的输血率也明显更高(14.1%vs.9.4%,P=0.003)。T-OPLL组住院时间更长(42.2天vs.36.2天,P=0.004)和更高的医疗费用(32,805美元对25,134美元,P<0.001)。在T-OPLL和T-OLF中,围手术期并发症的发生导致住院时间延长和医疗费用增加.虽然T-OPLL患者出院回家较少(51.6%vs.65.1%,P<0.001),患者更频繁地转移到其他医院(47.5%vs.33.5%,P=0.001)。
结论:本研究使用大型国家数据库在PDF中确定了T-OPLL和T-OLF的围手术期并发症,这表明T-OPLL患者局部并发症的发生率较高。围手术期并发症导致住院时间延长和医疗费用增加。
BACKGROUND: Although posterior decompression with fusion (PDF) are effective for treating thoracic myelopathy, surgical treatment has a high risk of various complications. There is currently no information available on the perioperative complications in thoracic ossification of the longitudinal ligament (T-OPLL) and thoracic ossification of the ligamentum flavum (T-OLF). We evaluate the perioperative complication rate and cost between T-OPLL and T-OLF for patients underwent PDF.
METHODS: Patients undergoing PDF for T-OPLL and T-OLF from 2012 to 2018 were detected in Japanese nationwide inpatient database. One-to-one propensity score matching between T-OPLL and T-OLF was performed based on patient characteristics and preoperative comorbidities. We examined systemic and local complication rate, reoperation rate, length of hospital stays, costs, discharge destination, and mortality after matching.
RESULTS: In a total of 2,660 patients, 828 pairs of T-OPLL and T-OLF patients were included after matching. The incidence of systemic complications did not differ significantly between the T-OPLL and OLF groups. However, local complications were more frequently occurred in T-OPLL than in T-OLF groups (11.4% vs. 7.7% P = 0.012). Transfusion rates was also significantly higher in the T-OPLL group (14.1% vs. 9.4%, P = 0.003). T-OPLL group had longer hospital stay (42.2 days vs. 36.2 days, P = 0.004) and higher medical costs (USD 32,805 vs. USD 25,134, P < 0.001). In both T-OPLL and T-OLF, the occurrence of perioperative complications led to longer hospital stay and higher medical costs. While fewer patients in T-OPLL were discharged home (51.6% vs. 65.1%, P < 0.001), patients were transferred to other hospitals more frequently (47.5% vs. 33.5%, P = 0.001).
CONCLUSIONS: This research identified the perioperative complications of T-OPLL and T-OLF in PDF using a large national database, which revealed that the incidence of local complications was higher in the T-OPLL patients. Perioperative complications resulted in longer hospital stays and higher medical costs.