Time to surgical management of distal radius fractures: effects on health care utilization and functional outcomes.

IF 2.2 4区 医学 Q2 SURGERY
Canadian Journal of Surgery Pub Date : 2024-07-04 Print Date: 2024-07-01 DOI:10.1503/cjs.010223
Kathy Liu, Emma J M Grigor, Daniel Antflek, George Ho, Heather L Baltzer, Ryan Paul
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Abstract

Background: Distal radius fractures are common injuries. Open reduction and internal fixation with volar locking plates is the most common approach for surgical fixation. This study investigated the association between time to surgery and health care utilization, income, and functional outcomes among patients undergoing open reduction and internal fixation for distal radius fracture.

Methods: We conducted a retrospective review of patients who underwent open reduction and internal fixation for isolated acute distal radius fracture between 2009 and 2019. Time to surgery was grouped as early (≤ 14 d) and delayed (> 14 d). We performed χ2 (or Fisher exact) and Wilcoxon rank sum (or Kruskal-Wallis) tests to provide statistical comparison of time to surgery by health care utilization and functional outcomes. Univariable and multivariable logistic regression analyses were performed to identify factors significantly associated with time to surgery. We included all significant univariables in the multivariable logistic regression model, which identified factors based on significant adjusted odds ratios (95% confidence intervals excluding the null) after we adjusted for confounding variables.

Results: We included 106 patients, with 36 (34.0%) in the group receiving early treatment and 70 (66.0%) in the group receiving delayed treatment. Patients in the delayed-treatment group attended significantly more clinic visits and postoperative hand therapy sessions. The group with delayed treatment demonstrated significantly lower degrees of wrist flexion at the first follow-up, but this difference did not persist. Patients with higher estimated income (> $39 405 per annum) had lower odds of delayed surgery than those with lower estimated income (≤ $39 405).

Conclusion: Delayed time to surgery was associated with greater health care utilization and lower degrees of early wrist flexion. Access to care for lower-income patients warrants further evaluation.

桡骨远端骨折的手术治疗时间:对医疗利用率和功能结果的影响。
背景:桡骨远端骨折是一种常见的损伤:桡骨远端骨折是一种常见的损伤。最常见的手术固定方法是切开复位内固定术,并使用沃尔锁定钢板。本研究调查了接受桡骨远端骨折切开复位内固定术的患者的手术时间与医疗使用、收入和功能结果之间的关系:我们对 2009 年至 2019 年期间因孤立性急性桡骨远端骨折接受切开复位内固定术的患者进行了回顾性研究。手术时间分为早期(≤ 14 d)和延迟(> 14 d)。我们进行了χ2(或费舍尔精确检验)和Wilcoxon秩和(或Kruskal-Wallis)检验,以统计比较医疗利用率和功能结果的手术时间。我们进行了单变量和多变量逻辑回归分析,以确定与手术时间显著相关的因素。我们将所有有意义的单变量纳入多变量逻辑回归模型,在调整混杂变量后,根据有意义的调整后几率比(95% 置信区间,不包括空值)确定因素:我们纳入了 106 名患者,其中早期治疗组有 36 人(34.0%),延迟治疗组有 70 人(66.0%)。延迟治疗组患者就诊次数和术后手部治疗次数明显增多。首次随访时,延迟治疗组的腕关节屈曲度明显较低,但这一差异并未持续。与估计收入较低(≤39 405美元)的患者相比,估计收入较高(>39 405美元/年)的患者推迟手术的几率较低:结论:延迟手术时间与更多的医疗保健使用和更低的早期腕关节屈曲度有关。低收入患者获得医疗服务的机会值得进一步评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.00
自引率
8.00%
发文量
120
审稿时长
6-12 weeks
期刊介绍: The mission of CJS is to contribute to the meaningful continuing medical education of Canadian surgical specialists, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.
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