Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA.
Orthop J Sports Med. 2014 Oct 10;2(10):2325967114553164. doi: 10.1177/2325967114553164. eCollection 2014 Oct.
Little data are available to prioritize quality improvement initiatives in shoulder surgery.
To stratify the risk for 30-day postoperative morbidity in commonly performed surgical procedures about the shoulder completed in a hospital setting and to determine patient factors associated with major complications.
Cohort study; Level of evidence, 3.
This retrospective study utilized the National Surgical Quality Improvement Program (NSQIP) database from the years 2005 to 2010. Using Current Procedural Terminology codes, the database was queried for shoulder cases that were divided into 7 groups: arthroscopy without repair; arthroscopy with repair; arthroplasty; clavicle/acromioclavicular joint (AC) open reduction and internal fixation (ORIF)/repair; ORIF of proximal humeral fracture; open tendon release/repair; and open shoulder stabilization. The primary end point was any major complication, with secondary end points of incisional infection, return to the operating room, and venothromboembolism (VTE), all within 30 days of surgery.
Overall, 11,086 cases were analyzed. The overall major complication rate was 2.1% (n = 234). Factors associated with major complications on multivariate analysis included: procedure performed (P < .001), emergency case (P < .001), pulmonary comorbidity (P < .001), preoperative blood transfusion (P = .033), transfer from an outside institution (P = .03), American Society of Anesthesiologists (ASA) score (P = .006), wound class (P < .001), dependent functional status (P = .027), and age older than 60 years (P = .01). After risk adjustment, open shoulder stabilization was associated with the greatest risk of major complications relative to arthroscopy without repair (odds ratio [OR], 5.56; P = .001), followed by ORIF of proximal humerus fracture (OR, 4.90; P < .001) and arthroplasty (OR, 4.40; P < .001). These 3 groups generated over 60% of all major complications. Open shoulder stabilization had the highest odds of reoperation (OR, 8.34; P < .001), while ORIF of proximal humerus fracture had the highest risk for VTE (OR, 6.47; P = .001) compared with the reference group of arthroscopy without repair.
Multivariable analysis of the NSQIP database suggests that open shoulder stabilization, ORIF for proximal humerus fractures, and shoulder arthroplasty are associated with the highest risk of major complications within 30 days after shoulder surgery in a hospital setting. Age, functional status, ASA score, pulmonary comorbidity, emergency case, preoperative blood transfusion, and transfer from an outside institution are patient variables that significantly influence complication risk.
关于肩部手术，可用于确定优先改进质量的措施的相关数据很少。
对在医院环境中进行的常见肩部手术术后 30 天内发生的发病率进行分层，并确定与主要并发症相关的患者因素。
队列研究；证据水平，3 级。
本回顾性研究利用了国家外科质量改进计划（NSQIP）数据库，时间范围为 2005 年至 2010 年。使用当前操作术语（Current Procedural Terminology，CPT）代码，对数据库进行了查询，以获取肩部手术案例，这些案例分为 7 组：关节镜检查而不修复；关节镜检查伴修复；关节置换术；锁骨/肩锁关节（AC）切开复位内固定术（ORIF）/修复；肱骨近端骨折的 ORIF；开放性肌腱松解/修复术；以及开放性肩部稳定术。主要终点是任何主要并发症，次要终点为切口感染、返回手术室以及静脉血栓栓塞症（VTE），均在术后 30 天内发生。
总共分析了 11086 例病例。总体主要并发症发生率为 2.1%（n=234）。多变量分析确定与主要并发症相关的因素包括：手术类型（P<0.001）、紧急情况（P<0.001）、肺部合并症（P<0.001）、术前输血（P=0.033）、来自其他医疗机构的转院（P=0.03）、美国麻醉医师协会（ASA）评分（P=0.006）、伤口分类（P<0.001）、依赖功能状态（P=0.027）以及年龄大于 60 岁（P=0.01）。经过风险调整后，与不进行关节镜检查相比，开放性肩部稳定术与主要并发症的最大风险相关（优势比[OR]，5.56；P=0.001），其次是肱骨近端骨折的 ORIF（OR，4.90；P<0.001）和关节置换术（OR，4.40；P<0.001）。这 3 组产生了超过 60%的所有主要并发症。开放性肩部稳定术的再手术风险最高（OR，8.34；P<0.001），而肱骨近端骨折的 ORIF 发生 VTE 的风险最高（OR，6.47；P=0.001），与不进行关节镜检查的参考组相比。
对 NSQIP 数据库的多变量分析表明，在医院环境中进行肩部手术后 30 天内，开放性肩部稳定术、肱骨近端骨折的 ORIF 和肩部置换术与主要并发症的风险最高。年龄、功能状态、ASA 评分、肺部合并症、紧急情况、术前输血以及来自其他医疗机构的转院是显著影响并发症风险的患者变量。
