Risk factors for cardiac complications after spine surgery

摘要

>Study design: Registry study using prospectively collected data>Objective: To determine risk factors for cardiac complications in spine surgery.>Methods: The Spine End Results Registry 2003–2004 is an exhaustive database of 1,592 patients who underwent spine surgery at the University of Washington Medical Center or Harborview Medical Center. Detailed information regarding patient demographic, medical comorbidity, surgical invasiveness and adverse outcomes were prospectively recorded. The primary outcome of measure was the occurrence of a cardiac complication in the perioperative period. Relative risk (RR) and 95% confidence intervals were calculated for each of the categorical variables. Multiple log-binomial regression analysis was performed to investigate the independent factors associated with cardiac complication.>Results: The incidence of cardiac complication after spine surgery was 6.7%. There were 136 cardiac complications in 107 patients after spine surgery. Age, diabetes, previous cardiac history, elevated adjusted Charlson comorbidity score, revision surgery, combined anterior-posterior approaches, and surgical invasiveness were statistically significant risk factors for cardiac complication after spine surgery.>Conclusions: The results of the present study suggest numerous statistically significant risk factors for cardiac complications after spine surgery. These results may aid the clinician with preoperative risk stratification and patient counseling. rules="all" class="rendered small default_table">>Methods evaluation and class of evidence (CoE)> valign="top" align="left" colspan="2" rowspan="1">>Methodological principle:> valign="top" align="left" colspan="2" rowspan="1">Study design:> valign="top" align="left" rowspan="1" colspan="1"> Prospective cohort valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Retrospective cohort (registry) valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Case control valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Case series valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" colspan="2" rowspan="1">Methods> valign="top" align="left" rowspan="1" colspan="1"> Patients at similar point in course of treatment valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Follow-up ≥85% valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Similarity of treatment protocols for patient groups valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Patients followed for long enough for outcomes to occur valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Control for extraneous risk factors valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1">>Evidence class: valign="top" align="center" rowspan="1" colspan="1">>IIThe definiton of the different classes of evidence is available on page 73.