Treskes Kaij, Voeten Stijn C, Tol Maria C J M, Zuidema Wietse P, Vermeulen Jefrey, Goslings J Carel, Schep Niels W L, van den Brand JG Han, van Velde Romuald, Haverlag Robert, Ultee Jan M, Postma Victor A, Twigt Bas A, van Dijkman Bart A, Heres Pieter, Winkelhagen Jasper, Klooster Mariska, Toor Annelies
Trauma Unit, Academic Medical Centre, Amsterdam, Netherlands.
Department of traumasurgery, Vrije Universiteit Medical Centre, Amsterdam, Netherlands.
Injury. 2017 Feb;48(2):339-344. doi: 10.1016/j.injury.2016.11.020. Epub 2016 Nov 18.
Surgery for proximal femoral fractures in the Netherlands is performed by trauma surgeons, general surgeons and orthopaedic surgeons. The aim of this study was to assess whether there is a difference in outcome for patients with proximal femoral fractures operated by trauma surgeons versus general surgeons. Secondly, the relation between hospital and surgeon volume and postoperative complications was explored.
Patients of 18 years and older were included if operated for a proximal femoral fracture by a trauma surgeon or a general surgeon in two academic, eight teaching and two non-teaching hospitals in the Netherlands from January 2010 until December 2013. The combined endpoint was defined as reoperation or surgical site infection. Multivariate analysis was used to adjust for patient and fracture characteristics and hospital and surgeon volume. Categories for hospital volume were>170/year (high volume), 96-170/year (medium volume) and <96/year (low volume).
In 4552 included patients 2382 (52.3%) had surgery by a trauma surgeon. Postoperative complications occurred in 276 (11.6%) patients operated by a trauma surgeon and in 258 (11.9%) operated by a general surgeon (p=0.751). When considering confounders in a multivariate analysis, surgery by trauma surgeons was associated with less postoperative complications (OR 0.746; 95%CI 0.580-0.958; p=0.022). Surgery in high volume hospitals was also associated with less complications (OR 0.997; 95%CI 0.995-0.999; p=0.012). Surgeon volume was not associated with complications (OR 1.008; 95%CI 0.997-1.018; p=0.175).
Surgery by trauma surgeons and high hospital volume are associated with less reoperations and surgical site infections for patients with proximal femoral fractures.
在荷兰，股骨近端骨折手术由创伤外科医生、普通外科医生和骨科医生进行。本研究的目的是评估创伤外科医生与普通外科医生为股骨近端骨折患者实施手术后的结局是否存在差异。其次，探讨医院及医生手术量与术后并发症之间的关系。
纳入2010年1月至2013年12月期间在荷兰两家学术医院、八家教学医院和两家非教学医院由创伤外科医生或普通外科医生为股骨近端骨折实施手术的18岁及以上患者。联合终点定义为再次手术或手术部位感染。采用多变量分析来调整患者和骨折特征以及医院和医生手术量。医院手术量的类别为>170例/年（高手术量）、96 - 170例/年（中等手术量）和<96例/年（低手术量）。
在纳入的4552例患者中，2382例（52.3%）由创伤外科医生进行手术。创伤外科医生手术的患者中有276例（11.6%）发生术后并发症，普通外科医生手术的患者中有258例（11.9%）发生术后并发症（p = 0.751）。在多变量分析中考虑混杂因素时，创伤外科医生进行的手术与较少的术后并发症相关（OR 0.746；95%CI 0.580 - 0.958；p = 0.022）。高手术量医院的手术也与较少的并发症相关（OR 0.997；95%CI 0.995 - 0.999；p = 0.012）。医生手术量与并发症无关（OR 1.008；95%CI 0.997 - 1.018；p = 0.175）。
对于股骨近端骨折患者，创伤外科医生进行的手术以及高医院手术量与较少的再次手术和手术部位感染相关。
