Gagnier Joel J, Morgenstern Hal, Kellam Patrick
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI USA.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI USA.
Patient Saf Surg. 2017 May 11;11:15. doi: 10.1186/s13037-017-0129-x. eCollection 2017.
This study's objective was to identify adverse events following common orthopaedic procedures, and to estimate the incidence rates and risks of these events and their associations with age, sex, and comorbidities.
This retrospective cohort study manually reviewed and extracted electronic medical data on the incidence and predictors of adverse events that occurred within 90 days of the 50 most frequent orthopaedic surgeries at an academic hospital in 2010. We also extracted demographic data, baseline comorbidities, and duration of follow-up (≤90 days). Patients were scored on the Charlson Comorbidity Index (CCI) and the Functional Comorbidity Index (FCI). We estimated incidence rates and risks for all events and associations using regression methods. Prolonged pain 42-days post-surgery was treated as a separate outcome.
We included 1,552 patients; average age was 53.4 years, and 51.7% were female. A total of 1,148 adverse events were identified in 729 patients. The incidence rate of all adverse events was 10 events per 1,000 person-days at risk; 47% of all patients experienced at least one adverse event within 90 days. The most frequent events were prolonged pain (31% of all adverse events) and persistent swelling (7%). We found positive associations between both comorbidity scores and the incidence rate and 90-day risk of all adverse events, excluding pain, adjusting for age and sex (neither of which was associated with adverse events); the association was stronger for the FCI than for the CCI. For total hip arthroplasty (THA) and total knee arthroplasty (TKA), the incidence rate of all adverse events, excluding pain, was positively associated with both comorbidity scores and age; the 90-day risk was positively associate with the FCI score and male sex. The prevalence of prolonged pain at 42 days was greater in patients with higher FCI scores; for THA and TKA only, pain prevalence was greater in those with higher FCI scores and in men.
Adverse events are frequent following common orthopaedic procedures. The incidence is greatest for patients with more functional comorbidities. For THA and TKA procedures, being male and being older are also associated with a greater incidence of adverse events.
本研究的目的是确定常见骨科手术后的不良事件，估计这些事件的发生率和风险，以及它们与年龄、性别和合并症的关联。
这项回顾性队列研究人工审查并提取了2010年一家学术医院50种最常见骨科手术90天内发生的不良事件的发生率和预测因素的电子医疗数据。我们还提取了人口统计学数据、基线合并症和随访时间（≤90天）。根据Charlson合并症指数（CCI）和功能合并症指数（FCI）对患者进行评分。我们使用回归方法估计所有事件、关联的发生率和风险。术后42天的持续性疼痛被视为一个单独的结果。
我们纳入了1552例患者；平均年龄为53.4岁，51.7%为女性。在729例患者中总共识别出1148例不良事件。所有不良事件的发生率为每1000人日有10例事件发生；47%的患者在90天内经历了至少一次不良事件。最常见的事件是持续性疼痛（占所有不良事件的31%）和持续性肿胀（7%）。我们发现，在调整年龄和性别后（年龄和性别均与不良事件无关），合并症评分与所有不良事件（不包括疼痛）的发生率和90天风险之间存在正相关；FCI的相关性比CCI更强。对于全髋关节置换术（THA）和全膝关节置换术（TKA），所有不良事件（不包括疼痛）的发生率与合并症评分和年龄均呈正相关；90天风险与FCI评分和男性性别呈正相关。FCI评分较高的患者在42天时持续性疼痛的患病率更高；仅对于THA和TKA，FCI评分较高的患者和男性的疼痛患病率更高。
常见骨科手术后不良事件频发。功能合并症较多的患者发生率最高。对于THA和TKA手术，男性和年龄较大也与不良事件的较高发生率相关。
