Perioperative risk stratification of spine trauma patients with ankylosing spinal disorders: a comparison of 3 quantitative indices.

Autor:	Lakomkin N; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Mikula AL; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Pinter ZW; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Wellings E; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Alvi MA; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Scheitler KM; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Pennington Z; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Lee NJ; 2Department of Orthopedics, Columbia University Medical Center, New York, New York., Freedman BA; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Sebastian AS; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Fogelson JL; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Bydon M; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Clarke MJ; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and., Elder BD; 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Spine [J Neurosurg Spine] 2022 May 27; Vol. 37 (5), pp. 722-728. Date of Electronic Publication: 2022 May 27 (Print Publication: 2022).
DOI:	10.3171/2022.4.SPINE211449
Abstrakt:	Objective: Patients with ankylosing spinal disorders (ASDs), including ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), have been shown to experience significantly increased rates of postoperative complications. Despite this, very few risk stratification tools have been validated for this population. As such, the purpose of this study was to identify predictors of adverse events and mortality in ASD patients undergoing surgery for 3-column fractures. Methods: All adult patients with a documented history of AS or DISH who underwent surgery for a traumatic 3-column fracture between 2000 and 2020 were identified. Perioperative variables, including comorbidities, time to diagnosis, and number of fused segments, were collected. Three instruments, including the Charlson Comorbidity Index (CCI), modified frailty index (mFI), and Injury Severity Score (ISS), were computed for each patient. The primary outcomes of interest included 1-year mortality, as well as postoperative complications. Results: A total of 108 patients were included, with a mean ± SD age of 73 ± 11 years. Of these, 41 (38%) experienced at least 1 postoperative complication and 22 (20.4%) died within 12 months after surgery. When the authors controlled for potential known confounders, the CCI score was significantly associated with postoperative adverse events (OR 1.20, 95% CI 1.00-1.42, p = 0.045) and trended toward significance for mortality (OR 1.19, 95% CI 0.97-1.45, p = 0.098). In contrast, mFI score and ISS were not significantly predictive of either outcome. Conclusions: Complications in spine trauma patients with ASD may be driven by comorbidity burden rather than operative or injury-related factors. The CCI may be a valuable tool for the evaluation of this unique population.
Databáze:	MEDLINE
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