背景:必须权衡化学预防(CPX)药物预防静脉血栓栓塞的益处和潜在风险。关于CPX在有或没有融合的椎板切除术后的疗效的现有文献是有限的,没有明确的共识来告知准则。
目的:本研究评估了CPX与腰椎椎板切除术伴融合术和不伴融合术后手术并发症之间的关系。
方法:对一家大型学术机构的患者进行回顾性研究。
方法:对2018年至2020年接受腰椎椎板切除术伴或不伴腰椎融合术的患者的病历进行了人口统计学分析,手术特点,CPX代理商,术后并发症,硬膜外血肿,和伤口引流。接受CPX的患者(n=316)与未接受CPX的患者(n=316)在倾向评分匹配后通过t检验进行比较,和CPX患者进一步分层融合状态。
结果:CPX组的体重指数和美国麻醉医师协会的评分较高。静脉血栓栓塞的发生率,硬膜外血肿,感染,术后切开引流,输血,伤口裂开,再次手术与CPX无关。潮湿的敷料更频繁,CPX的平均排水天数更长。CPX的术后总并发症发生率和住院时间(LOS)更大。融合亚组的Charlson合并症指数较低,美国麻醉医师协会的等级较低,更年轻,有更多的女人,并接受了更多的微创椎板切除术。虽然估计失血,手术时间,融合组的LOS明显更大,术中和术后并发症发生率无差异。
结论:腰椎椎板切除术后伴或不伴融合的CPX与硬膜外血肿发生率的增加无关,伤口并发症,或再次操作。接受CPX的患者术后心脏并发症较多,但外科医生可能更有可能为高危患者开CPX.他们也有更高的肠梗阻和潮湿的敷料,更大的LOS,和更长的排水持续时间。接受腰椎椎板切除术伴CPX融合术的患者往往风险较低,但失血更多,手术时间,LOS,心脏并发症,和血肿/血清瘤比未接受融合的患者。
结论:这项回顾性研究比较了接受化学预防和未接受化学预防的腰椎椎板切除术患者的手术并发症。化疗预防与硬膜外血肿发生率的增加无关,伤口并发症,或再次操作,但它与术后心脏并发症和肠梗阻的发生率较高有关。
方法:
BACKGROUND: The benefit of chemoprophylaxis (CPX) agents in preventing venous thromboembolism must be weighed against potential risks. Current literature regarding the efficacy of CPX after laminectomies with or without fusion is limited, with no clear consensus to inform guidelines.
OBJECTIVE: This study evaluated the association between CPX and surgical complications after lumbar laminectomy with and without fusion.
METHODS: Retrospective study of patients at a single large academic institution.
METHODS: The medical records of patients who underwent lumbar laminectomies with or without lumbar fusion from 2018 to 2020 were reviewed for demographics, surgical characteristics, CPX agents, postoperative complications, epidural hematomas, and wound drainage. Patients receiving CPX (n = 316) were compared with patients not receiving CPX (n = 316) via t test following propensity score matching, and patients on CPX were further stratified by fusion status.
RESULTS: The CPX group had higher body mass index and American Society of Anesthesiologists grades. Rates of venous thromboembolism, epidural hematomas, infections, postoperative incision and drainage, transfusions, wound dehiscence, and reoperation were not associated with CPX. Moist dressings were more frequent, and average days of drain duration were longer with CPX. Overall postoperative complication rate and length of stay (LOS) were greater with CPX. The fusion subgroup had a lower Charlson Comorbidity Index, had a lower American Society of Anesthesiologists grade, was younger, had more women, and underwent more minimally invasive laminectomies. While estimated blood loss, operative times, and LOS were significantly greater in the fusion group, there was no difference in rate of intraoperative and postoperative complications.
CONCLUSIONS: CPX after lumbar laminectomies with or without fusion was not associated with increased rates of epidural hematomas, wound complications, or reoperation. Patients receiving CPX had more postoperative cardiac complications, but it is possible that surgeons were more likely to prescribe CPX for higher-risk patients. They also had higher rates of ileus and moist dressings, greater LOS, and longer length of drain duration. Patients who underwent lumbar laminectomy with fusion on CPX tended to be lower risk yet incurred greater blood loss, operative times, LOS, cardiac complications, and hematomas/seromas than patients not undergoing fusion.
CONCLUSIONS: This retrospective study compared surgical complications of lumbar laminectomies in patients who received chemoprophylaxis vs patients who did not. Chemoprophylaxis was not associated with increased rates of epidural hematomas, wound complications, or reoperation, but it was associated with higher rates of postoperative cardiac complications and ileus.
METHODS: