A predictive model of perioperative myocardial infarction following elective spine surgery.

Autor: Passias PG; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA; New York Spine Institute, New York, NY, USA. Electronic address: peter.passias@nyumc.org., Pierce KE; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA; New York Spine Institute, New York, NY, USA., Alas H; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA; New York Spine Institute, New York, NY, USA., Bortz C; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA; New York Spine Institute, New York, NY, USA., Brown AE; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA; New York Spine Institute, New York, NY, USA., Vasquez-Montes D; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA., Oh C; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA., Wang E; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA., Jain D; New York Spine Institute, New York, NY, USA; Department of Orthopaedic Surgery, Washington University, St. Louis, MO., O'Connell BK; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA., Raad M; Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA; Department of Orthopaedics, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Diebo BG; Department of Orthopaedics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Orthopaedic Surgery, SUNY Downstate, New York, NY, USA., Soroceanu A; Department of Orthopaedic Surgery, SUNY Downstate, New York, NY, USA; Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada., Gerling MC; Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA; Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2022 Jan; Vol. 95, pp. 112-117. Date of Electronic Publication: 2021 Dec 09.
DOI: 10.1016/j.jocn.2021.11.032
Abstrakt: Myocardial infarction (MI), and its predictive factors, has been an understudied complication following spine operations. The objective was to assess the risk factors for perioperative MI in elective spine surgery patients as a retrospective case control study. Elective spine surgery patients with a perioperative MI were isolated in the NSQIP. The relationship between MI and non-MI spine patients was assessed using chi-squared and independent samples t-tests. Univariate/multivariate analyses assessed predictive factors of MI. Logistic regression with stepwise model selection was employed to create a model to predict MI occurrence. The study included 196,523 elective spine surgery patients (57.1 yrs, 48%F, 30.4 kg/m 2 ), and 436 patients with acute MI (Spine-MI). Incidence of MI did not change from 2010 to 2016 (0.2%-0.3%, p = 0.298). Spine-MI patients underwent more fusions than patients without MI (73.6% vs 58.4%, p < 0.001), with an average of 1.03 levels fused. Spine-MI patients also had significantly more SPO (5.0% vs 1.8%, p < 0.001) and 3CO (0.9% vs 0.2%, p < 0.001), but less decompression-only procedures (26.4% vs 41.6%, p < 0.001). Spine-MI underwent more revisions (5.3% vs 2.9%, p = 0.003), had greater invasiveness scores (3.41 vs 2.73, p < 0.001) and longer operative times (211.6 vs 147.3 min, p < 0.001). Mortality rate for Spine-MI patients was 4.6% versus 0.05% (p < 0.001). Multivariate modeling for Spine-MI predictors yielded an AUC of 83.7%, and included history of diabetes, cardiac arrest and PVD, past blood transfusion, dialysis-dependence, low preoperative platelet count, superficial SSI and days from operation to discharge. A model with good predictive capacity for MI after spine surgery now exists and can aid in risk-stratification of patients, consequently improving preoperative patient counseling and optimization in the peri-operative period.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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