1Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada 2Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 4Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada 5Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
J Bone Joint Surg Am. 2017 Aug 16;99(16):1365-1372. doi: 10.2106/JBJS.16.00843.
Orthopaedic procedures for degenerative musculoskeletal conditions (predominantly osteoarthritis and spinal stenosis) represent an increasing burden on the health-care system. These procedures are also associated with adverse event rates and related cost. The objective of this study was to identify risk factors for adverse events associated with orthopaedic surgeries as captured within a common clinical point-of-care system for documenting adverse events (Orthopaedic Surgical AdVerse Events Severity [OrthoSAVES] system).
In-hospital adverse events were recorded at the point of care over a 2-year period for inpatient elective knee, hip, and spine orthopaedic procedures for degenerative musculoskeletal conditions. Multivariable logistic regression was employed to investigate the association between various factors (age, sex, surgical site, body mass index, surgical risk classification, operative duration, length of stay, and medical comorbidities) and the occurrence of adverse events.
The sample included 2,146 patients. The overall adverse event rate was 27% (571 of 2,146), and by surgical site, the rates were 29% (130 of 442) for spine; 27% (266 of 998) for knee; and 25% (175 of 706) for hip. The most common adverse events had a low severity grade, but spinal procedures demonstrated more adverse events with a severity grade of ≥3. Increasing age (odds ratio [OR] = 1.21, 95% confidence interval [CI] =1.05 to 1.41, per 15-year interval), male sex (OR = 1.43, 95% CI =1.16 to 1.77), increasing operative duration (OR = 1.13, 95% CI = 1.03 to 1.23, per 30-minute increase), length of stay (OR = 1.13, 95% CI = 1.10 to 1.17, per day), and undergoing revision surgery (OR = 2.23, 95% CI = 1.35 to 3.70) were independently associated with a greater likelihood of the occurrence of an adverse event. Spine surgery demonstrated decreased odds of an adverse event compared with knee surgery (OR = 0.38, 95% CI = 0.23 to 0.61) when operative duration and length of stay were taken into account.
On the basis of our adjusted analysis, we found increasing age, male sex, revision surgery, length of stay, and increasing operative duration to be common independent risk factors for an adverse event across the population studied. The first 3 risk factors are not modifiable. The association between increasing operative duration and the risk of an adverse event across all anatomical regions and surgical procedures is a unique finding. However, modification of procedural efficiency is multifactorial and warrants further investigation.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
针对退行性肌肉骨骼疾病（主要为骨关节炎和脊柱狭窄症）的骨科手术给医疗保健系统带来了越来越大的负担。这些手术也与不良事件发生率和相关成本有关。本研究的目的是确定与骨科手术相关的不良事件的风险因素，这些风险因素是在记录不良事件的常见临床即时护理系统（骨科手术不良事件严重程度[OrthoSAVES]系统）中捕获的。
在 2 年期间，对退行性肌肉骨骼疾病的择期住院膝关节、髋关节和脊柱骨科手术的即时护理点记录院内不良事件。采用多变量逻辑回归分析各种因素（年龄、性别、手术部位、体重指数、手术风险分类、手术持续时间、住院时间和医疗合并症）与不良事件发生之间的关联。
该样本包括 2146 名患者。总体不良事件发生率为 27%（571/2146），按手术部位，脊柱为 29%（130/442）；膝关节为 27%（266/998）；髋关节为 25%（175/706）。最常见的不良事件严重程度较低，但脊柱手术的严重程度≥3 的不良事件更多。年龄增长（优势比[OR] = 1.21，95%置信区间[CI] = 1.05 至 1.41，每 15 年间隔）、男性（OR = 1.43，95%CI = 1.16 至 1.77）、手术持续时间增加（OR = 1.13，95%CI = 1.03 至 1.23，每增加 30 分钟）、住院时间（OR = 1.13，95%CI = 1.10 至 1.17，每天）和接受翻修手术（OR = 2.23，95%CI = 1.35 至 3.70）与不良事件发生的可能性增加独立相关。当考虑手术持续时间和住院时间时，脊柱手术与膝关节手术相比，不良事件的可能性降低（OR = 0.38，95%CI = 0.23 至 0.61）。
基于我们的调整分析，我们发现年龄增长、男性、翻修手术、住院时间和手术持续时间增加是研究人群中不良事件的常见独立危险因素。前 3 个风险因素是不可改变的。手术持续时间增加与所有解剖区域和手术程序的不良事件风险之间的关联是一个独特的发现。然而，手术效率的改善是多因素的，需要进一步研究。
治疗性 III 级。有关证据水平的完整描述，请参阅作者说明。
