Wilson Jacob M, Holzgrefe Russell E, Staley Christopher A, Schenker Mara L, Meals Clifton G
Emory University Orthopedics and Spine, Atlanta, GA.
Emory University Orthopedics and Spine, Atlanta, GA.
J Hand Surg Am. 2018 Aug;43(8):701-709. doi: 10.1016/j.jhsa.2018.05.029. Epub 2018 Jul 3.
Compared with cast treatment, surgery may expose patients with distal radius fractures to undue risk. Surgical intervention in this cohort may offer less benefit than previously thought and appropriate patient selection is imperative. The modified Frailty Index (mFI) predicts complications after other orthopedic surgeries. We hypothesized that this index would predict, and might ultimately prevent, complications in patients older than 50 years with distal radius fractures.
We retrospectively reviewed the American College of Surgeons-National Surgery Quality Improvement Program (ACS-NSQIP) database, including patients older than 50 years who underwent open reduction and internal fixation of a distal radius fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates, as well as length of stay (LOS) were recorded. Bivariate and multivariable statistical analysis was then performed.
We identified 6,494 patients (mean age, 65 years). Compared with patients with mFI of 0, patients with mFI of 2 or greater were nearly 2.5 times as likely to incur a postoperative complication (1.7% vs 7.4%). Specifically, the rates of Clavien-Dindo IV, wound, cardiac, and renal complications were increased significantly in patients with mFI of 2 or greater. In addition, as mFI increased from 0 to 2 or greater, 30-day reoperation rate increased from 0.8% to 2.4%, 30-day readmission from 0.8% to 4.6%, and LOS from 0.5 days to 1.44 days. Frailty was associated with increased complications as well as rates of readmission and reoperation even when controlling for demographic data, LOS, and operative time. Age alone was not significantly associated with postoperative complications, readmission, reoperation, or LOS.
A state of frailty is highly predictive of postoperative complications, readmission, reoperation, and increased LOS following open reduction and internal fixation of distal radius fractures. Our data suggest that a simple frailty evaluation can help inform surgical decision making in patients older than 50 years with distal radius fractures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
与石膏治疗相比，手术可能会使桡骨远端骨折患者面临不必要的风险。对这一队列患者进行手术干预的获益可能比之前认为的要少，因此必须进行恰当的患者选择。改良虚弱指数（mFI）可预测其他骨科手术后的并发症。我们假设该指数能够预测并最终预防50岁以上桡骨远端骨折患者的并发症。
我们回顾性分析了美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，纳入了50岁以上接受桡骨远端骨折切开复位内固定术的患者。然后为每位患者计算5项mFI评分。记录术后并发症、再入院率、再次手术率以及住院时间（LOS）。随后进行双变量和多变量统计分析。
我们纳入了6494例患者（平均年龄65岁）。与mFI为0的患者相比，mFI为2或更高的患者发生术后并发症的可能性几乎是前者的2.5倍（1.7%对7.4%）。具体而言，mFI为2或更高的患者中，Clavien-Dindo IV级、伤口、心脏和肾脏并发症的发生率显著增加。此外，随着mFI从0增加到2或更高，30天再次手术率从0.8%增加到2.4%，30天再入院率从0.8%增加到4.6%，住院时间从0.5天增加到1.44天。即使在控制了人口统计学数据、住院时间和手术时间后，虚弱状态仍与并发症增加以及再入院率和再次手术率升高相关。仅年龄与术后并发症、再入院、再次手术或住院时间无显著关联。
虚弱状态高度预测桡骨远端骨折切开复位内固定术后的并发症、再入院、再次手术以及住院时间延长。我们的数据表明，简单的虚弱评估有助于为50岁以上桡骨远端骨折患者的手术决策提供参考。
研究类型/证据水平：预后性研究II级。
