肱骨近端骨折手术治疗后的医院再入院情况：关节置换术比切开复位内固定术更安全吗？
Hospital readmissions after surgical treatment of proximal humerus fractures: is arthroplasty safer than open reduction internal fixation?
作者信息
Zhang Alan L, Schairer William W, Feeley Brian T
机构信息
Department of Orthopaedic Surgery, University of California San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA, 94158, USA,
出版信息
Clin Orthop Relat Res. 2014 Aug;472(8):2317-24. doi: 10.1007/s11999-014-3613-y. Epub 2014 Apr 15.
BACKGROUND
With technologic advances such as locked periarticular plating, hemiarthroplasty of the humeral head, and more recently reverse total shoulder replacement, surgical treatment of proximal humerus fractures has become more commonplace. However, there is insufficient information regarding patient outcomes after surgery, such as the frequency of unplanned hospital readmissions and factors contributing to readmission.
QUESTIONS/PURPOSES: We measured (1) the frequency of unplanned hospital readmissions after surgical treatment of proximal humerus fractures, (2) the medical and surgical causes of readmission, and (3) the risk factors associated with unplanned readmissions.
METHODS
The State Inpatient Database from seven different states was used to identify patients who underwent treatment for a proximal humerus fracture with open reduction and internal fixation (ORIF), hemiarthroplasty of the humeral head, or reverse total shoulder arthroplasty from 2005 through 2010. The database was used to measure the 30-day and 90-day readmission rates and identify causes and risk factors for readmission. Multivariate modeling and a Cox proportional hazards model were used for statistical analysis.
RESULTS
A total of 27,017 patients were included with an overall 90-day readmission rate of 14% (15% for treatment with ORIF, 15% for reverse total shoulder arthroplasty, and 13% for hemiarthroplasty). The majority of readmissions were associated with medical diagnoses (75%), but treatment with ORIF was associated with the most readmissions from surgical complications, (29%) followed by reverse total shoulder arthroplasty (20%) and hemiarthroplasty (16%) (p < 0.001). Risk of readmission was greater for patients who were female, African American, discharged to a nursing facility, or had Medicaid insurance.
CONCLUSIONS
As the majority of unplanned hospital readmissions were associated with medical diagnoses, it is important to consider patient medical comorbidities before surgical treatment of proximal humerus fractures and during the postoperative care phase.
LEVEL OF EVIDENCE
Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
背景
随着锁定关节周围钢板固定、肱骨头半关节置换术以及最近的反式全肩关节置换术等技术进步，肱骨近端骨折的外科治疗已变得更为常见。然而，关于手术后患者预后的信息不足，例如计划外再次入院的频率以及导致再次入院的因素。
问题/目的：我们测量了（1）肱骨近端骨折手术治疗后计划外再次入院的频率，（2）再次入院的内科和外科原因，以及（3）与计划外再次入院相关的危险因素。
方法
使用来自七个不同州的国家住院患者数据库，以识别2005年至2010年间接受切开复位内固定（ORIF）、肱骨头半关节置换术或反式全肩关节置换术治疗肱骨近端骨折的患者。该数据库用于测量30天和90天的再次入院率，并确定再次入院的原因和危险因素。采用多变量建模和Cox比例风险模型进行统计分析。
结果
共纳入27017例患者，总体90天再次入院率为14%（ORIF治疗为15%，反式全肩关节置换术为15%，半关节置换术为13%）。大多数再次入院与内科诊断相关（75%），但ORIF治疗因手术并发症导致的再次入院最多（29%），其次是反式全肩关节置换术（20%）和半关节置换术（16%）（p<0.001）。女性、非裔美国人、出院后入住护理机构或拥有医疗补助保险的患者再次入院风险更高。
结论
由于大多数计划外再次入院与内科诊断相关，因此在肱骨近端骨折手术治疗前和术后护理阶段考虑患者的内科合并症很重要。
证据水平
III级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
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