开放性桡骨远端骨折与闭合性桡骨远端骨折术后并发症：倾向评分匹配分析

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-01-01 DOI:10.1016/j.jhsg.2024.09.006

R. Cole Schmidt MD , Conor N. O’Neill MD , Zakkary J. Walterscheid MD , James R. Satalich MD , Jonathan Isaacs MD

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引用次数: 0

摘要

目的：主要目的是使用大样本量来比较手术治疗的开放性和闭合性桡骨远端骨折的30天感染率和其他围手术期结果。方法采用现行手术术语编码对2008年至2018年间接受桡骨远端骨折切开复位内固定的美国外科学会国家手术质量改进计划数据库中的患者进行识别，并将其分为开放性骨折（of）和闭合性骨折（CF）。采用10:1 （CF:OF）最近邻倾向评分匹配来解决人口统计学差异。组间感染率及其他结果比较。结果经切开复位内固定治疗CF 17536例，OF 401例。配对后，基线人口统计学差异无统计学意义(P >；. 05)。OF和CF之间深部手术部位感染的增加有统计学意义(0.2% vs 0.02%, P <；. 05)。OF组显著不良事件发生率更高(7.2% vs 1.6%, P <；0.05)，返回手术室(3.5% vs 0.9%, P <；.05)，平均住院时间(1.8 vs 0.7天，P <；0.05)，手术时间(90.8 vs 73.7 min, P <；（0.05），但从入院到手术室的时间没有差异（0.4天vs 0.3天）。结论与CF相比，OF的30天深部手术部位感染有统计学上的增加，但可能没有临床影响。OF患者的手术时间和住院时间明显更长，并且更频繁地返回手术室。这表明，与CF患者相比，许多OF患者在临床上并没有增加短期感染风险。研究类型/证据水平：预后，III级。

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Postoperative Complications After Operative Treatment of Open Versus Closed Distal Radius Fractures: A Propensity Score Matched Analysis

Purpose

The primary objective was to use a large sample size to compare 30-day infection rates and other perioperative outcomes between operatively treated open and closed distal radius fractures.

Methods

Patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent open reduction and internal fixation of a distal radius fracture between 2008 and 2018 were identified using Current Procedural Terminology codes and stratified into open (OF) and closed fractures (CF). A 10:1 (CF:OF) nearest neighbor propensity score matching was used to address demographic differences. Infection rate and other outcomes were compared between groups.

Results

A total 17,536 CF and 401 OF were treated by open reduction and internal fixation. After matching, baseline demographics were not statistically different (P > .05). There was a statistically significant increase in deep surgical site infections between OF and CF (0.2% vs 0.02%, P < .05). The OF cohort had a higher rate of significant adverse events (7.2% vs 1.6%, P < .05), return to the operating room (3.5% vs 0.9%, P < .05), mean length of stay (1.8 vs 0.7 days, P < .05), and operative time (90.8 vs 73.7 minutes, P < .05), but no difference in time from admission to the operating room (0.4 vs 0.3 days).

Conclusions

There was a statistically but probably not clinically impactful increase in 30-day deep surgical site infections in OF compared to CF. Patients with OF had significantly longer operative times and length of stay, and more often returned to the OR. This suggests that many OF patients do not carry a clinically increased short-term risk of infection when compared to CF patients.