Whiting Paul S, Rice Christopher D, Avilucea Frank R, Bulka Catherine M, Shen Michelle S, Obremskey William T, Sethi Manish K
Department of Orthopaedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin.
Department of Orthopaedic Surgery, University of Cincinnati Academic Health Center, Cincinnati, Ohio.
J Wrist Surg. 2017 Aug;6(3):220-226. doi: 10.1055/s-0037-1599216. Epub 2017 Mar 6.
The purpose of this study was to compare complication rates following inpatient versus outpatient distal radius fracture ORIF and identify specific complications that occur at increased rates among inpatients. Using the 2005-2013 ACS-NSQIP, we collected patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complications following isolated ORIF of distal radius fractures. A propensity score matched design using an 8-to-1 "greedy" matching algorithm in a 1:4 ratio of inpatients to outpatients was utilized. Rates of minor, major, and total complications were compared. A multinomial logistic regression model was then used to assess the odds of complications following inpatient surgery. Total 4,016 patients were identified, 776 (19.3%) of whom underwent inpatient surgery and 3,240 (80.3%) underwent outpatient surgery. The propensity score matching algorithm yielded a cohort of 629 inpatients who were matched with 2,516 outpatients (1:4 ratio). After propensity score matching, inpatient treatment was associated with increased rates of major and total complications but not with minor complications. There was an increased odds of major complications and total complications following inpatient surgery compared with outpatient surgery. There was no difference in odds of minor complications between groups. Inpatient operative treatment of distal radius fractures is associated with significantly increased rates of major and total complications compared with operative treatment as an outpatient. Odds of a major complication are six times higher and odds of total complications are two and a half times higher following inpatient distal radius ORIF compared with outpatient. Quality improvement measures should be specifically targeted to patients undergoing distal radius fracture ORIF in the inpatient setting.
本研究的目的是比较桡骨远端骨折切开复位内固定术住院治疗与门诊治疗后的并发症发生率，并确定住院患者中发生率增加的特定并发症。利用2005 - 2013年美国外科医师学会国家外科质量改进计划（ACS - NSQIP），我们收集了桡骨远端骨折单纯切开复位内固定术后患者的人口统计学资料、合并症、手术特征及术后30天并发症情况。采用倾向评分匹配设计，使用8比1的“贪婪”匹配算法，按住院患者与门诊患者1:4的比例进行匹配。比较了轻微、严重及总并发症的发生率。然后使用多项逻辑回归模型评估住院手术术后发生并发症的几率。共识别出4016例患者，其中776例（19.3%）接受了住院手术，3240例（80.3%）接受了门诊手术。倾向评分匹配算法产生了一组629例住院患者，与2516例门诊患者匹配（1:4比例）。倾向评分匹配后，住院治疗与严重及总并发症发生率增加相关，但与轻微并发症无关。与门诊手术相比，住院手术后发生严重并发症和总并发症的几率增加。两组间轻微并发症的几率无差异。与门诊手术治疗相比，桡骨远端骨折的住院手术治疗与严重及总并发症发生率显著增加相关。与门诊桡骨远端骨折切开复位内固定术相比，住院治疗后发生严重并发症的几率高6倍，发生总并发症的几率高2.5倍。质量改进措施应特别针对住院环境下接受桡骨远端骨折切开复位内固定术的患者。
