Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery
Abstract Background Rheumatoid arthritis (RA) often causes cervical spine lesions as the disease condition progresses, which induce occipital neuralgia or cervical myelopathy requiring surgical interventions. Meanwhile, patients with RA are susceptible to infection or other complications in the peri...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | Arthritis Research & Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13075-022-02767-0 |
| _version_ | 1811272054604824576 |
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| author | Koji Sakuraba Yuki Omori Kazuhiro Kai Kazumasa Terada Nobuo Kobara Satoshi Kamura Kenjiro Fujimura Hirofumi Bekki Masanari Ohta Hisa-aki Miyahara Jun-ichi Fukushi |
| author_facet | Koji Sakuraba Yuki Omori Kazuhiro Kai Kazumasa Terada Nobuo Kobara Satoshi Kamura Kenjiro Fujimura Hirofumi Bekki Masanari Ohta Hisa-aki Miyahara Jun-ichi Fukushi |
| author_sort | Koji Sakuraba |
| collection | DOAJ |
| description | Abstract Background Rheumatoid arthritis (RA) often causes cervical spine lesions as the disease condition progresses, which induce occipital neuralgia or cervical myelopathy requiring surgical interventions. Meanwhile, patients with RA are susceptible to infection or other complications in the perioperative period because they frequently have comorbidities and use immunosuppressive medications. However, the risk factors or characteristics of patients with RA who experience perioperative complications after cervical spine surgery remain unknown. A risk factor analysis of perioperative complications in patients with RA who underwent primary cervical spine surgery was conducted in the present study. Methods A total of 139 patients with RA who underwent primary cervical spine surgery from January 2001 to March 2020 were retrospectively investigated. Age and height, weight, serum albumin, serum C-reactive protein, American Society of Anesthesiologists Physical Status (ASA-PS), Charlson comorbidity index, medications used, cervical spine lesion, surgery time, bleeding volume, and procedures were collected from medical records to compare the patients with complications to those without complications after surgery. The risk factors for perioperative complications were assessed by univariate and multivariate logistic regression analysis. Results Twenty-eight patients (20.1%) had perioperative complications. Perioperative complications were significantly associated with the following factors [data presented as odds ratio]: lower height [0.928, p=0.007], higher ASA-PS [2.296, p=0.048], longer operation time [1.013, p=0.003], more bleeding volume [1.004, p=0.04], higher rates of vertical subluxation [2.914, p=0.015] and subaxial subluxation (SAS) [2.507, p=0.036], occipito-cervical (OC) fusion [3.438, p=0.023], and occipito-cervical/thoracic (long) fusion [8.021, p=0.002] in univariate analyses. In multivariate analyses, lower height [0.915, p=0.005], higher ASA-PS [2.622, p=0.045] and long fusion [7.289, p=0.008] remained risk factors. High-dose prednisolone use [1.247, p=0.028], SAS [6.413, p=0.018], OC fusion [17.93, p=0.034], and long fusion [108.1, p<0.001] were associated with severe complications. Conclusions ASA-PS and long fusion could be indicators predicting perioperative complications in patients with RA after cervical spine surgery. In addition, cervical spine lesions requiring OC fusion or long fusion and high-dose prednisolone use were suggested to be risk factors for increasing severe complications. |
| first_indexed | 2024-04-12T22:32:15Z |
| format | Article |
| id | doaj.art-e9ec942177e04a9aa2fb45ea4c4f43d5 |
| institution | Directory Open Access Journal |
| issn | 1478-6362 |
| language | English |
| last_indexed | 2024-04-12T22:32:15Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Arthritis Research & Therapy |
| spelling | doaj.art-e9ec942177e04a9aa2fb45ea4c4f43d52022-12-22T03:13:56ZengBMCArthritis Research & Therapy1478-63622022-03-0124111010.1186/s13075-022-02767-0Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgeryKoji Sakuraba0Yuki Omori1Kazuhiro Kai2Kazumasa Terada3Nobuo Kobara4Satoshi Kamura5Kenjiro Fujimura6Hirofumi Bekki7Masanari Ohta8Hisa-aki Miyahara9Jun-ichi Fukushi10Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical CenterClinical Research Center, National Hospital Organization Kyushu Medical CenterClinical Research Center, National Hospital Organization Kyushu Medical CenterDepartment of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical CenterDepartment of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical CenterDepartment of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical CenterClinical Research Center, National Hospital Organization Kyushu Medical CenterDepartment of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical CenterDepartment of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical CenterDepartment of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical CenterDepartment of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical CenterAbstract Background Rheumatoid arthritis (RA) often causes cervical spine lesions as the disease condition progresses, which induce occipital neuralgia or cervical myelopathy requiring surgical interventions. Meanwhile, patients with RA are susceptible to infection or other complications in the perioperative period because they frequently have comorbidities and use immunosuppressive medications. However, the risk factors or characteristics of patients with RA who experience perioperative complications after cervical spine surgery remain unknown. A risk factor analysis of perioperative complications in patients with RA who underwent primary cervical spine surgery was conducted in the present study. Methods A total of 139 patients with RA who underwent primary cervical spine surgery from January 2001 to March 2020 were retrospectively investigated. Age and height, weight, serum albumin, serum C-reactive protein, American Society of Anesthesiologists Physical Status (ASA-PS), Charlson comorbidity index, medications used, cervical spine lesion, surgery time, bleeding volume, and procedures were collected from medical records to compare the patients with complications to those without complications after surgery. The risk factors for perioperative complications were assessed by univariate and multivariate logistic regression analysis. Results Twenty-eight patients (20.1%) had perioperative complications. Perioperative complications were significantly associated with the following factors [data presented as odds ratio]: lower height [0.928, p=0.007], higher ASA-PS [2.296, p=0.048], longer operation time [1.013, p=0.003], more bleeding volume [1.004, p=0.04], higher rates of vertical subluxation [2.914, p=0.015] and subaxial subluxation (SAS) [2.507, p=0.036], occipito-cervical (OC) fusion [3.438, p=0.023], and occipito-cervical/thoracic (long) fusion [8.021, p=0.002] in univariate analyses. In multivariate analyses, lower height [0.915, p=0.005], higher ASA-PS [2.622, p=0.045] and long fusion [7.289, p=0.008] remained risk factors. High-dose prednisolone use [1.247, p=0.028], SAS [6.413, p=0.018], OC fusion [17.93, p=0.034], and long fusion [108.1, p<0.001] were associated with severe complications. Conclusions ASA-PS and long fusion could be indicators predicting perioperative complications in patients with RA after cervical spine surgery. In addition, cervical spine lesions requiring OC fusion or long fusion and high-dose prednisolone use were suggested to be risk factors for increasing severe complications.https://doi.org/10.1186/s13075-022-02767-0Rheumatoid arthritisCervical spine surgeryPerioperative complicationsOccipito-cervical/thoracic fusionOccipito-cervical fusionCervical spine lesion |
| spellingShingle | Koji Sakuraba Yuki Omori Kazuhiro Kai Kazumasa Terada Nobuo Kobara Satoshi Kamura Kenjiro Fujimura Hirofumi Bekki Masanari Ohta Hisa-aki Miyahara Jun-ichi Fukushi Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery Arthritis Research & Therapy Rheumatoid arthritis Cervical spine surgery Perioperative complications Occipito-cervical/thoracic fusion Occipito-cervical fusion Cervical spine lesion |
| title | Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery |
| title_full | Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery |
| title_fullStr | Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery |
| title_full_unstemmed | Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery |
| title_short | Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery |
| title_sort | risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery |
| topic | Rheumatoid arthritis Cervical spine surgery Perioperative complications Occipito-cervical/thoracic fusion Occipito-cervical fusion Cervical spine lesion |
| url | https://doi.org/10.1186/s13075-022-02767-0 |
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