Cotter Eric J, Gowd Anirudh K, Bohl Daniel D, Getgood Alan, Cole Brian J, Frank Rachel M
Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Cartilage. 2020 Oct;11(4):423-430. doi: 10.1177/1947603518798889. Epub 2018 Sep 6.
To characterize rates and risk factors for adverse events following distal femoral osteotomy (DFO), high tibial osteotomy (HTO), and tibial tubercle osteotomy (TTO) procedures.
Patients undergoing DFO, HTO, or TTO procedures during 2005 to 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Rates of adverse events were characterized for each procedure. Demographic, comorbidity, and procedural factors were tested for association with occurrence of any adverse events.
A total of 1,083 patients were identified. Of these, 305 (28%) underwent DFO, 273 (25%) underwent HTO, and 505 (47%) underwent TTO. Mean ages for patients undergoing each procedure were the following: DFO, 51 ± 23 years; HTO, 40 ± 13 years; and TTO, 31 ± 11 years. The most common comorbidities for DFO were hypertension (34%) and smoking (17%); for HTO, hypertension (22%) and smoking (21%); and for TTO, smoking (20%) and hypertension (11%). Independent risk factors for occurrence of any adverse event were age ⩾45 years for DFO (odds ratio [OR] = 3.1, < 0.001) and HTO (OR = 2.3, = 0.029), and body mass index >30 for HTO (OR = 2.5, 95% confidence interval = 1.1-5.7, = 0.031). When all osteotomy procedures were analyzed collectively, additional variables including diabetes mellitus (OR = 2.2, = 0.017), chronic obstructive pulmonary disease (OR = 5.5, = 0.003), and dependent functional status (OR = 3.0, = 0.004) were associated with adverse events.
The total rate of adverse events was not independently associated with the type of osteotomy procedure. In addition, patients with age >45, diabetes mellitus, chronic obstructive pulmonary disease, and dependent functional status have greater odds for adverse events and should be counseled and monitored accordingly.
描述股骨远端截骨术（DFO）、胫骨高位截骨术（HTO）和胫骨结节截骨术（TTO）术后不良事件的发生率及危险因素。
在美国外科医师学会国家外科质量改进计划中识别出2005年至2016年期间接受DFO、HTO或TTO手术的患者。对每种手术的不良事件发生率进行描述。对人口统计学、合并症和手术因素与任何不良事件的发生进行关联测试。
共识别出1083例患者。其中，305例（28%）接受了DFO，273例（25%）接受了HTO，505例（47%）接受了TTO。接受每种手术患者的平均年龄如下：DFO为51±23岁；HTO为40±13岁；TTO为31±11岁。DFO最常见的合并症是高血压（34%）和吸烟（17%）；HTO为高血压（22%）和吸烟（21%）；TTO为吸烟（20%）和高血压（11%）。DFO和HTO发生任何不良事件的独立危险因素是年龄≥45岁（DFO的比值比[OR]=3.1，P<0.001；HTO的OR=2.3，P=0.029），HTO的体重指数>30（OR=2.5，95%置信区间=1.1 - 5.7，P=0.031）。当对所有截骨手术进行综合分析时，包括糖尿病（OR=2.2，P=0.017）、慢性阻塞性肺疾病（OR=5.5，P=0.003）和依赖性功能状态（OR=3.0，P=0.004）等其他变量与不良事件相关。
不良事件的总发生率与截骨手术类型无独立关联。此外，年龄>45岁、患有糖尿病、慢性阻塞性肺疾病和依赖性功能状态的患者发生不良事件的几率更高，应相应地给予咨询和监测。
