| With an aging population,the prevalence of vertebral compression fracture(VCF)in elderly populations is increasing,and became the most common type of osteoporotic fracture.International Osteoporosis Foundation estimated that one patient discovered vertebral compression fracture caused by osteoporosis every 22 seconds worldwide.Another study found that the prevalence of spinal fractures in white men and women over the age of 50 was as high as 20-25%in 2010.Percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)are minimally invasive techniques,which are commonly used to treat osteoporotic vertebral compression fractures,with the advantages of smaller incision,shorter operation time,less bleeding and faster recovery.There is no difference in biomechanical properties between the two surgical techniques,which can effectively relieve pain,stabilize fractures,enable patients to move as early as possible,and greatly improve their quality of life.Although the advantages of PVP and PKP are obvious,the risk of postoperative complications cannot be ignored,especially in elderly patients.For younger patients,the postoperative complications,such as lung inflammation,are not that serious.But for elderly patients,physical impairments and the surgery trauma,even a minimally invasive surgery,will significantly increase the risk of respiratory failure and mortality,if the postoperative complications can’t be prevented and treated properly.The occurrence of postoperative pulmonary complications prolongs the hospital stay,increases the expenses,decreases the quality of life,and causes great psychological pressure to patients and their families.Based on the analysis of associated risk factors,the study aimed to build a simple risk assessment scale of pulmonary complications in the elderly patients after VCF minimally invasive surgery with clinical practical value.This study carried out from three aspects,which were summarized as follows.Part 1 Risk factors of pulmonary complications after minimally invasivesurgery for VCF in elderly patientsObjective:To study the risk factors of pulmonary complications after minimally invasive surgery in elderly VCF,and provide references for the strategies and measures to prevent them.Methods:A retrospective study was conducted on elderly VCF patients treated with PVP or PKP in Hebei General Hospital from January 2011 to December 2016.Statistical analysis was performed with SPSS 21.0(IBM)software.Continuous variables were expressed as mean±standard deviation,and analyzed by independent sample T test.Categorical variables and rates were compared by one-way ANOVA.When the variances were uniform and there were significant differences,the S-N-K test was used to make pairwise comparisons.When the variances were not uniform,a non-parametric rank sum test was used.The risk factors of pulmonary complications after minimally invasive surgery for elderly VCF patients were analyzed by non-conditional binomial logistic regression analysis.The dependent variable was the presence or absence of pulmonary complications.Statistically significant factors among the above risk factors were included in non-conditional binary taxonomy regression model.The area under curve(AUC)was used to evaluate the effect of logistic regression model.The curve was receiver operating characteristic(ROC).Results:Among the 233 patients included in the retrospective analysis,27(11.59%)had pulmonary complications,including 7 cases of pleural effusion and 20 cases of pulmonary infection.The average age of 27 patients was 78.89±7.65 years old,including 11 female(20.74%)and 16 male(59.26%).There were 206 cases(88.41%)without pulmonary complications,with an average age of 75.56±6.62 years,of which 148 were female(71.84%)and 58 were male(28.16%).The results of univariate statistical analysis showed that patients with pulmonary complications after minimally invasive surgery had statistical significance in age,BMI,smoking,cardiovascular disease and old fracture(P<0.05).Conclusions:Logistic regression analysis showed that BMI(Body Mass Index),cardiovascular disease and old fracture were independent risk factors of pulmonary complications in elderly VCF patients after PVP or PKP(P<0.05).AUC were 0.738,95%confidence interval was 0.648-0.828,indicating that the prediction effect of this logistic regression model is reliable.Part 2 Establishment of a simple scale for risk assessment of pulmonaryinvasive surgeryObjective:To build a simple risk assessment scale for pulmonary complications after minimally invasive surgery for the elderly VCF(Abbreviated as:Risk assessment simple scale)on the basis of the study results of the first part,relevant literature reports and experts?recommendations.Methods:SPSS 21.0(IBM)software was used for statistical analysis.The risk factors of pulmonary complications after minimally invasive surgery for the elderly VCF were analyzed by non-conditional binomial logistic regression analysis.The dependent variable was whether pulmonary complications occurred.The covariates were age,BMI,smoking,cardiovascular disease and old fracture.Logistic regression model was constructed to estimate the regression coefficientβ,OR value and 95%CI of each risk factor.According to the statistical results estimated by the Logistic regression model and expert opinions,we add other relevant risk factors,and assign values to each risk factor.With reference to POSSUM(Physiological and Operative Severity Score system for counting mortality and morbidity),we adjust the index value of each risk factor reasonably,and form a simple risk assessment scale.Results:Among 27 patients with pulmonary complications,2 cases were predicted by logistic regression equation,the accuracy rate was(2/27)7.4%;among 206 patients without pulmonary complications,203 cases were predicted by logistic regression equation,the accuracy rate was(203/206)98.5%;the total accuracy rate was 88.0%(205/233).The independent variables entering the regression equation were BMI,cardiovascular disease and old fracture.The ratio of postoperative pulmonary complications of overweight and obese patients was 3.368 compared with that of normal BMI patients;the ratio of postoperative pulmonary complications of patients with cardiovascular disease to those without cardiovascular disease was 2.807;the ratio of postoperative pulmonary complications of patients with old fractures to those without old fractures was 5.065.Chi square test,χ~2=18.914,P=0.000,so logistic regression equation has statistical significance.Conclusions:The evaluation factors of the risk assessment simple scale include preoperative evaluation factors and postoperative evaluation factors.Preoperative evaluation factors include age,BMI,smoking duration,number of chronic diseases,vertebral compression fracture duration and bed duration.If the patient has chronic lung diseases,additional points will be added separately.Postoperative evaluation factors include preoperative hospital days,anesthesia type and operation time.The scores are 0,1,2 and 3.The highest score of preoperative evaluation was 19 points,and the highest total score of postoperative evaluation was 28 points.A higher score indicates a higher risk of pulmonary complications after minimally invasive surgery for elderly VCF.Part 3 Clinical application of Risk assessment simple scale for elderlypatients with VCFs after minimally invasive surgeryObjective:The aim was to observe and verify the simple risk assessment scale in clinical practice,and to determine a standard of high-risk patients.Methods:A prospective study was conducted on elderly VCF patients treated with PVP or PKP in Hebei General Hospital from July to December2017.Risk assessment simple scale was used to evaluate the study subjects.SPSS 21.0(IBM)software was used for statistical analysis.AUC was used to evaluate the effect of the prediction model.According to the sensitivity and specificity,the cutoff point with the largest sum of the two was selected as the boundary value to determine the criteria of high-risk patients.Results:Among the 53 patients included in the study,5 patients had pulmonary complications(3 pleural effusion,2 pulmonary infection)after PVP/PKP treatment,3 males and 2 females,with an average age of 84.6 years(72-94 years);48 patients without pulmonary complications after minimally invasive surgery,9 males and 39 females,with an average age of 74.3 years(65-90 years).Among patients with pulmonary complications,the lowest preoperative and postoperative evaluation scores 11 and 15 points,the highest scores 15 and 19 points.Among patients without pulmonary complications,the lowest preoperative and postoperative evaluation scores 4 and 7 points,the highest scores 13 and 18 points.Conclusions:The area under ROC curve of preoperative and postoperative scores 0.925,indicating the accuracy of"Risk assessment simple scale".Synthesizing sensitivity and specificity to determine the criteria for identifying high-risk patients.The results showed that the risk of pulmonary complications was quite high in the elderly patients with preoperative score more than 10.5 and postoperative total score more than14.5.Patients with scores lower than these two values have a relatively low risk. |
