Outcome-relevante Faktoren in der Wirbelsäulenchirurgie

Bei vielen unterschiedlichen Parametern ist eine Beeinflussung des Verlaufs und dementsprechend ein potenzieller Einfluss auf das Outcome von Wirbelsäulenoperationen vorstellbar. Zum einen sind dies individuelle patientenspezifische Voraussetzungen, zum anderen Faktoren, die die präoperative Vorbereitung, die Operation an sich sowie den postoperativen Verlauf beeinflussen. Ziel dieses Artikels ist es, nachgewiesene Outcome-relevanten Faktoren für Wirbelsäulenoperationen aufzuführen und zu strukturieren.

Abstract

Several parameters might influence the outcome after vertebral spine surgeries. In order to find these a systematic literature search was performed. Thereby, a total of 62 articles were selected. All outcome-relevant parameters were categorized into patient-specific, course-specific, and radiologic parameters. Furthermore, scores were included which help to estimate the risk of adverse events and outcome for certain pathologies and/or surgeries. Patient-specific parameters were predominantly the patient age and several specific secondary diagnoses such as diabetes, adipositas, depression, anxiety disorders, and nicotine abuse. Additionally, the patient expectation plays an important role in the subjective outcome assessment. Course-specific parameters are mainly perioperative factors such as surgical experience, particularly in highly demanding vertebral spine surgeries. Furthermore, modern intraoperative equipment such as intraoperative CT and neuromonitoring helps to increase patient safety. The most outcome-relevant radiologic parameters are those which define the sagittal balance. Thereby, a correct sagittal balance is associated with superior clinical outcomes.

Fazit

Outcome-relevante Parameter

Die Outcome-relevanten Parameter wurden eingeteilt in

• patientenspezifische Faktoren

• verlaufsspezifische Faktoren

  • präoperativ

  • intraoperativ

  • postoperativ

• radiologische Faktoren

Zuletzt werden „Scores“ zusammengefasst, mit denen Operationsergebnisse und/oder Komplikationsrisiken abgeschätzt werden können.

Fazit

Take Home Message

Zur Optimierung des subjektiven Behandlungsergebnisses nach Wirbelsäulenoperationen spielt eine korrekte Erwartungshaltung eine entscheidende Rolle. Diese kann über eine ausführliche und wirklichkeitsgetreue Aufklärung sowie Verweise auf sinnvolle Informationsquellen optimiert werden. Die Aufklärung sollte eine realistische Darstellung des Verbesserungspotenzials, nicht jedoch das Ziel einer absoluten Beschwerdefreiheit aufzeigen.

Zudem sollten potenzielle Komplikationen und die Gefahr eines verzögerten Heilverlaufs verständlich übermittelt werden.

Fazit

Take Home Message

Insgesamt ist die Kenntnis dieser Faktoren von herausragender Bedeutung. Nur so lässt sich eine kontinuierliche Optimierung der Patientenaufklärung, Entwicklung von realistischeren Erwartungshaltungen und als Ultimo Ratio die Verbesserung der Behandlungsergebnisse erzielen.

Kernaussagen

• Zahlreiche Faktoren haben Einfluss auf das Outcome von Wirbelsäulenoperationen. Zur Erfassung dieser erfolgte eine systematische Literaturrecherche, wobei insgesamt 62 Artikel als relevant eingestuft und ausgewählt wurden.

• Die Outcome-relevanten Faktoren wurden in patientenspezifische Faktoren, verlaufsspezifische Faktoren sowie radiologische Faktoren unterteilt. Zudem wurden Scores aufgeführt, mit deren Hilfe Voraussagen über Komplikationshäufigkeit bzw. das klinische Outcome möglich erschien.

• Patientenspezifische Faktoren, die einen Einfluss auf das Outcome haben, sind insbesondere das Patientenalter sowie einige Nebenerkrankungen (wie z. B. Diabetes mellitus, Adipositas, Depression, Angststörung, Nikotinabusus).

• Darüber hinaus scheint die Erwartungshaltung der Patienten einen wichtigen Einfluss auf das subjektive Outcome zu besitzen.

• Von Seiten der verlaufs- bzw. operationsspezifischen Outcome-relevanten Faktoren hat vor allem die Operation an sich einen hohen Effekt. Dabei spielt insbesondere bei technisch anspruchsvollen Operationen die Erfahrung des Chirurgen eine entscheidende Rolle.

• Zudem können je nach Pathologie moderne Zusatzverfahren wie das intraoperative CT oder das Neuromonitoring die Patientensicherheit verbessern.

• Von Seiten der radiologischen Faktoren spielt die Wiederherstellung des korrekten sagittalen Alignements eine wichtige Rolle.

Schlüsselwörter

Wirbelsäulenchirurgie - Outcome - Patientensicherheit - Erwartungshaltung - Literaturrecherche

Keywords

spine surgery - patient expectation - literature search - adverse event - patient safety

Publikationsverlauf

Artikel online veröffentlicht:
29. Oktober 2020

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