Xie Jack, Malik Azeem Tariq, Quatman Carmen E, Ly Thuan V, Phieffer Laura S, Khan Safdar N
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Foot Ankle Spec. 2020 Apr;13(2):93-103. doi: 10.1177/1938640019826692. Epub 2019 Feb 2.
Metabolic syndrome (MetS) is associated with significant postoperative morbidity. Despite an increasing prevalence of MetS in the US population, its impact on postoperative outcomes following ankle fractures remains limited. The 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program database was queried for patients undergoing open reduction with internal fixation (ORIF) for ankle fractures using Current Procedural Terminology codes: 27766, 27769, 27792, 27814, 27822, and 27823. The study cohort was divided into 2 groups: MetS versus No MetS. MetS was identified using a predefined criteria as the coexistence of (1) diabetes mellitus, (2) hypertension, and (3) body mass index ≥30 kg/m. A total of 1013 (6.7%) MetS underwent ORIF for ankle fractures. Following adjustment for baseline differences, MetS was an independent predictor of experiencing any 30-day complication (odds ratio [OR] = 1.35; = .020), wound complications (OR = 1.67; = .024), renal complications (OR = 3.54; = .022), 30-day readmissions (OR = 1.66; = .001), 30-day unplanned reoperations (OR = 1.69; = .009) and decreased odds of home discharge (OR = 0.66; < .001). Patients with MetS undergoing ORIF for ankle fractures are at an increased risk of experiencing adverse 30-day complications, readmissions, and reoperations. Providers should understand the need of appropriate postoperative surveillance in this high-risk group to minimize the risk of poor outcomes. .
代谢综合征（MetS）与显著的术后发病率相关。尽管在美国人群中MetS的患病率不断上升，但其对踝关节骨折术后结局的影响仍然有限。利用当前手术操作术语编码：27766、27769、27792、27814、27822和27823，查询2012 - 2016年美国外科医师学会 - 国家外科质量改进计划数据库中接受踝关节骨折切开复位内固定术（ORIF）的患者。研究队列分为两组：MetS组和非MetS组。MetS根据预先定义的标准确定为同时存在（1）糖尿病，（2）高血压，以及（3）体重指数≥30kg/m²。共有1013例（6.7%）患有MetS的患者接受了踝关节骨折的ORIF手术。在对基线差异进行调整后，MetS是发生任何30天并发症（比值比[OR]=1.35；P = 0.020）、伤口并发症（OR = 1.67；P = 0.024）、肾脏并发症（OR = 3.54；P = 0.022）、30天再入院（OR = 1.66；P = 0.001）、30天非计划再次手术（OR = 1.69；P = 0.009）以及出院回家几率降低（OR = 0.66；P < 0.001）的独立预测因素。接受踝关节骨折ORIF手术的MetS患者发生不良30天并发症、再入院和再次手术的风险增加。医疗服务提供者应了解在这一高危人群中进行适当术后监测的必要性，以将不良结局的风险降至最低。
