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脊柱转移的计划性与非计划性手术的短期结果

Ali Haider Bangash^1,2, Sertac Kirnaz^1,2, Rose Fluss^1,2

¹Spine Tumor Mechanics and Outcomes Research (TUMOR) Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.

|July 29, 2025

概括

转移性脊椎病 (MSD) 的非计划性手术与更糟糕的结果有关. 这包括较高的救援失败率,30天死亡率和较长的住院时间,相比于脊髓瘤的计划手术.

科学领域:

在瘤学瘤学.
神经外科神经外科
手术结果研究研究.

背景情况:

转移性脊椎病 (MSD) 是晚期癌症的常见并发症,通常需要手术干预来缓解疼痛,稳定性和神经系统的保存.
虽然有计划的瘤脊柱手术是首选的,但由于急性恶化,大量患者接受了未计划的 (紧急/紧急) 程序.
手术规划状态对MSD手术结果的影响尚未得到充分理解.

研究的目的:

为了比较患者特征和脊髓转移的计划和计划外手术之间的短期术后结果.
为了确定影响为转移性脊柱疾病进行手术的患者的结果的因素.

主要方法:

使用美国外科医生学院国家外科质量改进计划 (ACS-NSQIP) 数据库 (2018-2023) 的回顾性队列研究.
确定了经过脊髓瘤手术的患有扩散癌症的患者,并将他们分为计划 (可选) 和非计划 (紧急/紧急) 组.
主要终点:没有救援 (FTR). 二级终点:30天主要并发症,30天死亡率和住院时间. 统计分析包括单变量和多变量回归.

主要成果:

在2147名患者中,60%是有计划的,40%是无计划的手术.
非计划性手术患者表现出较高的严重低白血症,严重贫血和ASA类IV状态 (p ≤ 0.001).
多变量分析显示,无计划手术与增加的FTR (OR 2.11,p=0.005),30天死亡率 (OR 1.84,p=0.002) 和更长的住院时间 (β 2.7,p<0.001) 有显著的关联,但与30天重大并发症 (p=0.08) 没有独立关联.

结论:

转移性脊柱疾病的非计划性手术独立地与显著更高的救援失败率,30天死亡率和延长住院时间有关.
这些发现强调了及时识别和管理MSD患者的关键重要性.
优先考虑半选择性外科护理可能会改善脊髓转移患者的治疗结果.

关键词:

克莱维恩·丁多 (Clavien Dindo) 是一个著名的钢琴家.没有进行救援.停留的时间长度.转移性脊椎病的发生.死亡率死亡率没有计划的手术.

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