■随着出现心脏病和充血性心力衰竭的选择性脊柱融合患者数量的增加,评估何时进行手术是安全的变得越来越困难。通过射血分数评估心力衰竭(HF)的严重程度可能有助于深入了解患者的短期和长期风险。
■本研究的目的是评估HF严重程度对脊柱融合手术患者围手术期预后的影响。
■这是PearlDiver数据库的回顾性队列研究。
■我们招募了670,526名接受脊柱融合手术的患者。
■30天和90天并发症发生率,排放目的地,停留时间(LOS)医生报销,医院费用。
■接受择期脊柱融合手术的患者被隔离并根据术前HF进行分层,并保留射血分数(P-EF)或降低射血分数(R-EF)(国际疾病分类-9:428.32[慢性舒张性HF]和428.22[慢性收缩性HF])。均值比较检验(卡方检验和独立样本t检验,酌情)比较人口统计学差异,诊断,合并症,程序特征,LOS,30天和90天并发症结果,以及被诊断为P-EF和非R-EF的患者之间的总医院费用。二元逻辑回归评估与HF相关的并发症的几率,控制融合水平(比值比[OR][95%置信区间])。P<0.05时具有统计学意义。
■共纳入670,526例择期脊柱融合患者。四千七十七人被诊断为P-EF和2758R-EF。总的来说,P-EF患者的病态肥胖率较高,慢性肾病,慢性阻塞性肺疾病,糖尿病,和高血压(均P<0.001)。关于无HF,P-EF患者30天主要并发症的发生率较高,包括肺栓塞,肺炎,脑血管意外(CVA),心肌梗塞(MI),脓毒症,和死亡(均P<0.001)。此外,P-EF与肺炎几率增加显著相关(OR:2.07[1.64-2.56],P<0.001)和脓毒症(OR:2.09[1.62-2.66],P<0.001)。相对于无HF,R-EF与MI的几率显着相关(OR:3.66[2.34-5.47]),CVA(OR:2.70[1.67-4.15]),术后30天内合并肺炎(OR:1.85[1.40-2.40])(均P<0.001)。根据MI的先前历史进行调整,CAD,并且起搏器R-EF的存在是术后30天MI的重要预测因子(OR:2.2[1.14-4.32],P=0.021)。进一步调整CABG或支架放置史,R-EF与较高的CVA几率相关(OR:2.11[1.09-4.19],P=0.028)和MI(OR:2.27[1.20-4.43],P=0.013)。
■在脊柱手术前评估HF的严重程度时,R-EF与较高的主要并发症风险相关,尤其是术后30天发生心肌梗死。在术前风险评估中,在考虑术后结局时,应充分考虑充血性HF,重点是R-EF。
UNASSIGNED: With the increasing amount of elective spine fusion patients presenting with cardiac disease and congestive heart failure, it is becoming difficult to assess when it is safe to proceed with surgery. Assessing the severity of heart failure (HF) through ejection fraction may provide insight into patients\' short- and long-term risks.
UNASSIGNED: The purpose of this study was to assess the severity of HF on perioperative outcomes of spine fusion surgery patients.
UNASSIGNED: This was a retrospective cohort study of the PearlDiver database.
UNASSIGNED: We enrolled 670,526 patients undergoing spine fusion surgery.
UNASSIGNED: Thirty-day and 90-day complication rates, discharge destination, length of stay (LOS), physician reimbursement, and hospital costs.
UNASSIGNED: Patients undergoing elective spine fusion surgery were isolated and stratified by preoperative HF with preserved ejection fraction (P-EF) or reduced ejection fraction (R-EF) (International Classification of Diseases-9: 428.32 [chronic diastolic HF] and 428.22 [chronic systolic HF]). Means comparison tests (Chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, LOS, 30-day and 90-day complication outcomes, and total hospital charges between those diagnosed with P-EF and those not R-EF. Binary logistic regression assessed the odds of complication associated with HF, controlling for levels fused (odds ratio [OR] [95% confidence interval]). Statistical significance was set at P < 0.05.
UNASSIGNED: Totally 670,526 elective spine fusion patients were included. Four thousand and seventy-seven were diagnosed with P-EF and 2758 R-EF. Overall, P-EF patients presented with higher rates of morbid obesity, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension (all P < 0.001). In relation to No-HF, P-EF patients had higher rates of 30-day major complications including pulmonary embolism, pneumonia, cerebrovascular accident (CVA), myocardial infarctions (MI), sepsis, and death (all P < 0.001). Furthermore, P-EF was associated significantly with increased odds of pneumonia (OR: 2.07 [1.64-2.56], P < 0.001) and sepsis (OR: 2.09 [1.62-2.66], P < 0.001). Relative to No-HF, R-EF was associated with significantly higher odds of MI (OR: 3.66 [2.34-5.47]), CVA (OR: 2.70 [1.67-4.15]), and pneumonia (OR: 1.85 [1.40-2.40]) (all P < 0.001) postoperative within 30 days. Adjusting for prior history of MI, CAD, and the presence of a pacemaker R-EF was a significant predictor of an MI 30 days postoperatively (OR: 2.2 [1.14-4.32], P = 0.021). Further adjusting for history of CABG or stent placement, R-EF was associated with higher odds of CVA (OR: 2.11 [1.09-4.19], P = 0.028) and MI (OR: 2.27 [1.20-4.43], P = 0.013).
UNASSIGNED: When evaluating the severity of HF before spine surgery, R-EF was associated with a higher risk of major complications, especially the occurrence of a myocardial infarction 30 days postoperatively. During preoperative risk assessment, congestive HF should be considered thoroughly when thinking of postoperative outcomes with emphasis on R-EF.