The risk factors of major adverse cardiac events after posterior lumbar spinal fusion in patients with degenerative lumbar spinal disorders

English Keywords:Degenerative lumbar spinal disorders  Posterior lumbar spinal fusion  Major adverse cardiac events  Risk factors

English Abstract:

  【Abstract】 Objectives: To explore the factors that may be associated with the occurrence of major adverse cardiac events(MACEs) after posterior lumbar spinal fusion in patients with degenerative lumbar spinal disorders. Methods: The clinical data of 96 patients who underwent lumbar spinal fusion for degenerative lumbar spinal disorders at Beijing Anzhen Hospital from January 2018 to July 2023 were retrospectively analyzed, 53 males and 44 females were included with the average age of 64.1±10.1 years. The patients were grouped according to whether MACEs(cardiac arrest, new or worsening arrhythmia, acute myocardial infarction, or angina pectoris and heart failure) occurred within 1 year after lumbar spine fusion surgery. The general conditions[American Society of Anesthesiologists(ASA) classification, Charlson comorbidity index(CCI), revised cardiac risk index(RCRI), etc.], preoperative examinations(hematocrit, serum albumin, left ventricular ejection fraction, etc.), surgical parameters(Mirza invasiveness of the surgery index, operative time, estimated blood loss, etc.), and intraoperative monitoring indexes(baseline mean artery pressure, urine output, autonomous blood transfusion, etc.) were compared between the two groups. Results: The CCI index, RCRI index, echocardiograph E-wave maximal flow rate, estimated intraoperative blood loss, baseline mean arterial pressure, and intraoperative autologous blood transfusion in the group without MACEs were significantly lower than those in the group with (0.9±1.0 vs 1.6±1.5; 1.5±0.7 vs 2.0±0.8; 70.3±18.2 vs 82.6±36.9; 705±560.6 vs 1193±1332.9; 103.6±15.9 vs 112.1±12.1; 399.5±368.3 vs 637.6±470.5), with statistically significant differences(P＜0.05). Multifactorial logistic regression analysis suggested that both the CCI index and estimated intraoperative blood loss were correlated with the MACEs statistically(OR=1.968, P=0.007; OR=1.001, P=0.023). Conclusions: The CCI and operative blood loss may be associated with the MACEs after posterior lumbar spinal fusion in patients with degenerative lumbar spinal disorders.