Serum Alkaline Phosphatase as a Predictor of Cardiac and Cerebrovascular Complications after Lumbar Spinal Fusion Surgery in Elderly: A Retrospective Study
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Study Endpoints
2.3. Other Assessments
2.4. Statistical Analysis
3. Results
4. Discussion
Author Contributions
Acknowledgments
Conflicts of Interest
References
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ALP (IU/L) | Total | ALP < 63 | ALP = 63–79 | ALP > 79 | p-Value |
---|---|---|---|---|---|
n | 1395 | 468 | 463 | 464 | |
Age, yrs | 72 ± 4 | 72 ± 4 | 72 ± 4 | 72 ± 5 | 0.758 |
Female | 903 (64.7) | 297 (63.5) | 298 (64.5) | 308 (66.4) | 0.634 |
BMI, kg/m2 | 24.92 ± 3.01 | 24.82 ± 2.88 | 24.91 ± 3.02 | 25.04 ± 3.12 | 0.526 |
ASA class ≥ 3 | 453 (32.5) | 148 (33.5) | 144 (33.2) | 161 (33.3) | 0.450 |
Current smoker | 109 (7.8) | 39 (8.3) | 38 (8.2) | 32 (6.9) | 0.665 |
Hypertension | 822 (58.8) | 275 (58.8) | 270 (58.3) | 277 (59.7) | 0.909 |
Diabetes | 304 (21.8) | 104 (22.2) | 94 (20.3) | 106 (22.8) | 0.620 |
Coronary artery disease | 73 (5.2) | 17 (3.6) | 27 (5.8) | 29 (6.3) | 0.155 |
Chronic kidney disease | 47 (3.4) | 17 (3.6) | 20 (4.3) | 10 (2.2) | 0.175 |
COPD | 9 (0.6) | 2 (0.4) | 3 (0.6) | 4 (0.9) | 0.709 |
Preoperative Medication | |||||
Beta blockers | 139 (10.0) | 43 (9.2) | 60 (13.0) | 36 (7.8) | 0.024 |
CCBs | 408 (29.2) | 146 (31.2) | 124 (26.8) | 138 (29.7) | 0.321 |
RAS blockers | 521 (37.3) | 173 (37.0) | 172 (37.1) | 176 (37.9) | 0.949 |
Statins | 370 (26.5) | 123 (26.3) | 124 (26.8) | 123 (26.5) | 0.981 |
Diuretics | 191 (13.7) | 57 (12.2) | 65 (14.0) | 69 (14.9) | 0.473 |
LVEF, % | 66.3 ± 6.2 | 66.5 ± 6.1 | 66.3 ± 6.0 | 66.0 ± 6.5 | 0.626 |
Laboratory Data | |||||
Albumin, g/m | 4.42 ± 0.46 | 4.45 ± 0.52 | 4.39 ± 0.35 | 4.42 ± 0.48 | 0.164 |
ALT, U/L | 20 (16–27) | 20 (16–26) | 20 (15–27) | 20 (16–29) | 0.119 |
AST, U/L | 23 (20–27) | 23 (20–26) | 23 (20–27) | 24 (20–29) | 0.087 |
Calcium, mg/dL | 9.23 ± 0.89 | 9.27 ± 1.00 | 9.18 ± 0.64 | 9.26 ± 0.98 | 0.260 |
Total cholesterol, mg/dL | 195.13 ± 45.57 | 196.12 ± 45.29 | 193.98 ± 42.80 | 195.28 ± 48.50 | 0.774 |
Creatinine, mg/dL | 0.73 ± 0.23 | 0.74 ± 0.25 | 0.72 ± 0.21 | 0.73 ± 0.22 | 0.384 |
Hemoglobin, g/dL | 13.38 ± 1.31 | 13.31 ± 1.29 | 13.44 ± 1.23 | 13.39 ± 1.42 | 0.360 |
Total bilirubin, mg/dL | 0.61 ± 0.25 | 0.60 ± 0.24 | 0.60 ± 0.25 | 0.63 ± 0.26 | 0.130 |
Phosphorus, mg/dL | 3.76 ± 0.60 | 3.77 ± 0.60 | 3.77 ± 0.55 | 3.72 ± 0.65 | 0.381 |
ALP, IU/L | 74.27 ± 24.93 | 52.04 ± 7.29 | 70.73 ± 4.91 | 100.23 ± 24.61 | < 0.001 |
ALP (IU/L) | Total | ALP < 63 | ALP = 63–79 | ALP > 79 | p-Value |
---|---|---|---|---|---|
n | 1395 | 468 | 463 | 464 | |
Intraoperative Data | |||||
Number of fusion level | 1 (1–2) | 2 (1–2) | 1 (1–2) | 1 (1–2) | 0.233 |
Multi-level fusion (>3) | 74 (5.3) | 29 (6.2) | 16 (3.5) | 29 (6.3) | 0.095 |
Surgery time, min | 230.61 ± 74.11 | 234.62 ± 72.77 | 227.34 ± 74.19 | 229.83 ± 75.33 | 0.313 |
Fluid, mL | 2200 (1650–2850) | 2200 (1700–2850) | 2150 (1650–2750) | 2150 (1650–2900) | 0.630 |
Bleeding, mL | 700 (500–1100) | 700 (500–1100) | 650 (500–1100) | 800 (500–1200) | 0.114 |
Number of patients transfused with pRBCs | 343 (24.6) | 114 (24.4) | 104 (22.5) | 125 (26.9) | 0.283 |
RBC transfused, mL | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–240) | 0.317 |
Urine Output, mL | 600 (350–1000) | 550 (330–950) | 600 (350–1000) | 635 (350–1000) | 0.329 |
Postoperative Data | |||||
Myocardial infarction | 9 (0.6) | 2 (0.4) | 1 (0.2) | 6 (1.3) | 0.095 |
Stroke | 5 (0.4) | 1 (0.2) | 0 (0.0) | 4 (0.9) | 0.073 |
Death | 1 (0.1) | 0 (0.0) | 0 (0.0) | 1 (0.2) | 0.366 |
Composite (MACCE) | 13 (0.9) | 2 (0.4) | 1 (0.2) | 10 (2.2) | 0.003 |
MV > 24 h | 4 (0.3) | 2 (0.4) | 1 (0.2) | 1 (0.2) | 0.784 |
ICU admission | 73 (5.2) | 24 (5.1) | 25 (5.4) | 24 (5.2) | 0.980 |
LOS after surgery, day | 10 (9–12) | 10 (9–12) | 10 (9–12) | 11 (9–13) | 0.097 |
No MACCE | MACCE | p-Value | |
---|---|---|---|
n | 1382 | 13 | |
Age, years | 72 ± 4 | 72 ± 4 | 0.683 |
Female sex | 892 (64.5) | 11 (84.6) | 0.132 |
BMI, kg/m2 | 24.92 ± 3.01 | 24.76 ± 2.72 | 0.921 |
ASA class ≥ 3 | 450 (32.6) | 3 (23.1) | 0.467 |
Hypertension | 814 (58.9) | 8 (61.5) | 0.847 |
Diabetes | 299 (21.6) | 5 (38.5) | 0.144 |
Coronary artery disease | 72 (5.2) | 1 (7.7) | 0.690 |
Chronic kidney disease | 46 (3.3) | 1 (7.7) | 0.385 |
COPD | 9 (0.7) | 0 (0.0) | 0.770 |
Preoperative Medication | |||
Beta blockers | 138 (10.0) | 1 (7.7) | <0.999 |
CCBs | 403 (29.2) | 5 (38.5) | 0.541 |
RAS blockers | 516 (37.3) | 5 (38.5) | <0.999 |
Statins | 365 (26.4) | 5 (38.5) | 0.348 |
Diuretics | 190 (13.7) | 1 (7.7) | 0.451 |
Preoperative Laboratory Data | |||
Hemoglobin | 13.38 ± 1.31 | 13.18 ± 1.11 | 0.342 |
Creatinine | 0.73 ± 0.23 | 0.80 ± 0.27 | 0.464 |
ALP, IU/L | 74.2 ± 24.9 | 84.5 ± 15.4 | 0.139 |
First/Second/Third tertiles | 466 (33.7)/462 (33.4)/454 (32.9) | 2 (15.3)/1 (7.6)/10 (76.9) | 0.006 |
Multi-level fusion (> 3) | 73 (5.3) | 1 (7.6) | 0.509 |
Operation time, min | 221 (181–270) | 225 (165–315) | 0.438 |
Bleeding, mL | 700 (500–1100) | 800 (550–1100) | 0.571 |
RBC transfused, mL | 0 (0–0) | 0 (0–360) | 0.541 |
Univariate | Multivariate | |||
---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
Age, years | 0.993 (0.874–1.127) | 0.910 | ||
Female sex | 3.021 (0.667–3.021) | 0.151 | 2.913 (0.641–13.243) | 0.166 |
Diabetes | 2.264 (0.735–6.971) | 0.154 | 2.188 (0.707–6.778) | 0.175 |
Coronary artery disease | 1.515 (0.194–11.813) | 0.692 | ||
Chronic kidney disease | 2.420 (0.308–19.010) | 0.401 | ||
ALP third tertile | 4.599 (1.409–15.014) | 0.011 | 4.507(1.378–14.739) | 0.013 |
Bleeding amount, mL | 1.002 (1.000–1.004) | 0.387 |
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You, A.H.; Han, D.W.; Ham, S.Y.; Lim, W.; Song, Y. Serum Alkaline Phosphatase as a Predictor of Cardiac and Cerebrovascular Complications after Lumbar Spinal Fusion Surgery in Elderly: A Retrospective Study. J. Clin. Med. 2019, 8, 1111. https://doi.org/10.3390/jcm8081111
You AH, Han DW, Ham SY, Lim W, Song Y. Serum Alkaline Phosphatase as a Predictor of Cardiac and Cerebrovascular Complications after Lumbar Spinal Fusion Surgery in Elderly: A Retrospective Study. Journal of Clinical Medicine. 2019; 8(8):1111. https://doi.org/10.3390/jcm8081111
Chicago/Turabian StyleYou, Ann Hee, Dong Woo Han, Sung Yeon Ham, Wonsik Lim, and Young Song. 2019. "Serum Alkaline Phosphatase as a Predictor of Cardiac and Cerebrovascular Complications after Lumbar Spinal Fusion Surgery in Elderly: A Retrospective Study" Journal of Clinical Medicine 8, no. 8: 1111. https://doi.org/10.3390/jcm8081111