手术时间对髋部骨折手术固定效果的影响:35710例患者的多变量回归分析。

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-03-01 Epub Date: 2023-10-05 DOI:10.1177/11207000231203527
Alvaro Ibaseta, Ahmed Emara, Pedro J Rullán, Daniel C Santana, Mitchell K Ng, Daniel Grits, Viktor E Krebs, Robert M Molloy, Nicolas S Piuzzi
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引用次数: 0

摘要

背景:髋关节骨折切开复位内固定术后,手术时间延长是增加发病率和死亡率的危险因素。然而,这种关联的数量性质,包括分级风险水平,尚待描述。本研究概述了手术时间与(1)医疗保健利用率和(2)髋部骨折ORIF后30天并发症之间的分级关系。方法:查询国家外科质量改进计划(NSQIP)数据库(2016年1月至2019年12月)中所有接受髋关节骨折ORIF的患者(n = 35710)。记录人口统计学、手术时间、骨折类型和合并症。结果包括医疗保健利用率(例如,住院时间延长[LOS>2 天],出院处理,30天再次入院和再次手术),术后第1天不能负重(ITWB)(POD-1),以及任何30天并发症。调整后的多变量回归模型评估了手术时间和测量结果之间的相关性。结果:手术时间讨论:手术时间的增加与髋关节骨折ORIF后不良后果几率的逐渐增加有关。虽然无法建立直接因果关系,但
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of operative time in outcomes following surgical fixation of hip fractures: a multivariable regression analysis of 35,710 patients.

Background: Prolonged operative time is a risk factor for increased morbidity and mortality after open reduction and internal fixation (ORIF) of hip fractures. However, the quantitative nature of such association, including graduated risk levels, has yet to be described. This study outlines the graduated associations between operative time and (1) healthcare utilisation, and (2) 30-day complications after ORIF of hip fractures.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried (January 2016-December 2019) for all patients who underwent ORIF of hip fractures (n = 35,710). Demographics, operative time, fracture type, and comorbidities were recorded. Outcomes included healthcare utilisation (e.g., prolonged length of stay [LOS>2 days], discharge disposition, 30-day readmission, and reoperation), inability to weight-bear (ITWB) on postoperative day-1 (POD-1), and any 30-day complication. Adjusted multivariate regression models evaluated associations between operative time and measured outcomes.

Results: Operative time <40 minutes was associated with lower odds of prolonged LOS (odds ratio [OR] 0.77), non-home discharge (OR 0.85), 30-day readmission (OR 0.85), and reoperation (OR 0.72). Operative time ⩾80 minutes was associated with higher odds of ITWB on POD-1 (OR 1.17). Operative time ⩾200 minutes was associated with higher odds of deep infection (OR 7.5) and wound complications (OR 3.2). The odds of blood transfusions were higher in cases ⩾60 minutes (OR1.3) and 5-fold in cases ⩾200 minutes (OR 5.4). The odds of venous thromboembolic complications were highest in the ⩾200-minute operative time category (OR 2.5). Operative time was not associated with mechanical ventilation, pneumonia, delirium, sepsis, urinary tract infection, or 30-day mortality.

Discussion: Increasing operative time is associated with a progressive increase in the odds of adverse outcomes following hip fracture ORIF. While a direct cause-effect relationship cannot be established, an operative time of <60 minutes could be protective. Perioperative interventions that shorten operative time without compromising fracture reduction or fixation should be considered.

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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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