生理能力与手术应激评分系统预测退变性脊柱侧凸围手术期并发症的临床研究

Clinical study of E-PASS system for peri-operative morbidity of spinal surgery for degenerative scoliosis

目的探讨生理能力与手术应激评分(estimation of physiologic ability and surgical stress,E-PASS)系统预测退变性脊柱侧凸围手术期并发症的可行性.方法回顾性分析2013年1月至2017年7月接受内固定融合手术治疗227例退变性脊柱侧凸患者的病历资料,男57例,女170例;年龄50~84岁,平均(66.2±7.7)岁.术前采用E-PASS系统的指标进行评估,即术前生理评分(preoperative risk score,PRS)、手术应激评分(surgical stress score,SSS)和综合风险评分(compre-hensive risk score,CRS).术后记录围手术期出现的并发症情况,根据围手术期(术后30 d内)有无发生并发症分为有并发症组和无并发症组,两组间总住院时间和术后住院时间的比较采用t检验,两组间PRS、SSS和CRS的比较采用Mann-Whit-ney U检验,采用Spearman相关性分析分析并发症发生与PRS、SSS和CRS的相关性,对PRS、SSS和CRS生成预测并发症发生应用标准受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积(the area under the ROC curve,AUC)值判断PRS、SSS和CRS的预测有效性.结果共47例(20.7%)发生围手术期并发症,手术部位并发症27例(11.9%),非手术部位并发症23例(10.1%).有并发症组总住院时间(t=-4.722,P<0.001)和术后住院时间(t=-4.867,P<0.001)均明显延长;有并发症组患者PRS(P=0.005)、SSS(P=0.003)和CRS(P<0.001)均明显高于无并发症组,且呈线性相关(ρ=0.185~0.259);PRS与非手术部位并发症明显相关(ρ=0.162),SSS与手术部位并发症明显相关(ρ=0.169).ROC曲线结果显示PRS对非手术部位并发症的预测有一定准确性(AUC=0.655),SSS对手术部位并发症的预测有一定准确性(AUC=0.650),CRS对这两种并发症的预测有一定准确性(AUC=0.662和0.631).结论退变性脊柱侧凸内固定融合手术的围手术期并发症发生率较高,E-PASS系统对预测其并发症的发生具有一定的价值.

Objective To evaluate the feasibility of the Estimation of Physiologic Ability and Surgical Stress(E-PASS)system to predict peri-operative risk in degenerative scoliosis patients scheduled for spinal surgery.Methods Clinical data of 227 cases with degenerative scoliosis(Male∶Female=57∶170,Mean age=66.2±7.7 years),who accepted the operation of instrumen-tation and fusion in our hospital from January 2013 to July 2017,were retrospectively reviewed according to the E-PASS system,including peri-operative complications.Both hospital stayand post-operative hospital staywere compared between the groups with and withoutthe complications using t test.All E-PASS scores,including Preoperative Risk Score(PRS),Surgical Stress Score(SSS)and Comprehensive Risk Score(CRS),were analyzed between the two groups using Mann-Whitney Utest.The relationship between complications and PRS,SSS and CRS were analyzed using Spearmancorrelation analysis.The predictiveaccuracy of PRS,SSS and CRS were analyzed using the area under the receiver operating characteristic(ROC)curve(AUC).Results There were a total of 47 patients(20.7%)suffering peri-operative complications,including 27 cases(11.9%)with complications at surgical sites and 23 cases(10.1%)with complications at non-surgical sites.Both hospital stay(t=-4.722,P<0.001)and post-operative hospital stay(t=-4.867,P<0.001)were increased because of the complications.All E-PASS scores,including PRS(P=0.005),SSS(P=0.003)and CRS(P<0.001)were significantly higher in patients with peri-operative complications and they were linearly correlated with the overall incidence of the complications(ρ=0.185-0.259).In particular,PRS was correlated with complications at non-surgical sites(ρ=0.162)and SSS with surgical site complications(ρ=0.162).The area under the receiver operating characteristic curve(AUC)for PRS and SSS was higher in patients with complications at non-surgical and surgical sites(AUC=0.655 and 0.650),respectively.The AUC for CRS exhibited good predictive power for both types of complications(AUC=0.662 and 0.631).Conclusion The peri-operative morbidity of spinal surgery for degenerative scoliosis was relatively higher.The E-PASS system could correctly predict the morbidity.