The Effects of Peri-Operative Adverse Events on Clinical and Patient-Reported Outcomes After Surgery for Degenerative Cervical Myelopathy: An Observational Cohort Study from the Canadian Spine Outcomes and Research Network.
Neurosurgery
; 95(2): 437-446, 2024 Aug 01.
Article
em En
| MEDLINE
| ID: mdl-38465953
ABSTRACT
BACKGROUND AND OBJECTIVES:
There is a lack of data examining the effects of perioperative adverse events (AEs) on long-term outcomes for patients undergoing surgery for degenerative cervical myelopathy. We aimed to investigate associations between the occurrence of perioperative AEs and coprimaryoutcomes:
(1) modified Japanese Orthopaedic Association (mJOA) score and (2) Neck Disability Index (NDI) score.METHODS:
We analyzed data from 800 patients prospectively enrolled in the Canadian Spine Outcomes and Research Network multicenter observational study. The Spine AEs Severity system was used to collect intraoperative and postoperative AEs. Patients were assessed at up to 2 years after surgery using the NDI and the mJOA scale. We used a linear mixed-effect regression to assess the influence of AEs on longitudinal outcome measures as well as multivariable logistic regression to assess factors associated with meeting minimal clinically important difference (MCID) thresholds at 1 year.RESULTS:
There were 167 (20.9%) patients with minor AEs and 36 (4.5%) patients with major AEs. The occurrence of major AEs was associated with an average increase in NDI of 6.8 points (95% CI 1.1-12.4, P = .019) and reduction of 1.5 points for mJOA scores (95% CI -2.3 to -0.8, P < .001) up to 2 years after surgery. Occurrence of major AEs reduced the odds of patients achieving MCID targets at 1 year after surgery for mJOA (odds ratio 0.23, 95% CI 0.086-0.53, P = .001) and for NDI (odds ratio 0.34, 95% CI 0.11-0.84, P = .032).CONCLUSION:
Major AEs were associated with reduced functional gains and worse recovery trajectories for patients undergoing surgery for degenerative cervical myelopathy. Occurrence of major AEs reduced the probability of achieving mJOA and NDI MCID thresholds at 1 year. Both minor and major AEs significantly increased health resource utilization by reducing the proportion of discharges home and increasing length of stay.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Doenças da Medula Espinal
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Vértebras Cervicais
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Medidas de Resultados Relatados pelo Paciente
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Neurosurgery
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Canadá