Malik Azeem Tariq, Quatman Carmen E, Phieffer Laura S, Jain Nikhil, Khan Safdar N, Ly Thuan V
Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States.
J Clin Orthop Trauma. 2019 Sep-Oct;10(5):890-895. doi: 10.1016/j.jcot.2019.02.010. Epub 2019 Feb 12.
Pelvic/acetabular fractures are associated with significant morbidity, mortality and cost to the society. We sought to utilize a national surgical database to assess the incidence and factors associated with prolonged length of stay (LOS), non-home discharge destination, 30-day adverse events and readmissions following surgical fixation of pelvic/acetabular fractures.
MATERIALS & METHODS: The 2011-2016 ACS-NSQIP database files were queried using CPT codes (27215, 27217, 27218, 27226, 27227, 27228) for patients undergoing open reduction/internal fixation (ORIF) for pelvic/acetabular fractures. Patients undergoing additional procedures for associated fractures (vertebral fractures, distal radius/ulna fractures or femoral neck/hip fractures) were excluded from the analysis to ensure that a relevant population of patients with isolated pelvic/acetabular injuries were included in the analysis. A total of 572 patients were included in the final cohort. Severe adverse events (SAE) were defined as: death, ventilator use >48 h, unplanned intubation, stroke, deep venous thrombosis, pulmonary embolism, cardiac arrest, myocardial infarction, acute renal failure, sepsis, septic shock, re-operation, deep SSI and organ/space SSI. Minor adverse events (MAE) included - wound dehiscence, superficial SSI, urinary tract infection (UTI) and progressive renal insufficiency. An extended LOS was defined as >75th centile (>9days).
Factors associated with AAE were partially dependent functional health status pre-operatively (p = 0.020), transfusion ≥1 unit of packed RBCs (p = 0.001), and ASA > II (p < 0.001). Experiencing a SAE was associated with congestive heart failure (CHF) pre-operatively [p = 0.005), total operative time >140 min (p = 0.034) and Hct <36 pre-operatively (p = 0.003). MAE was associated with transfusion≥1 unit of packed RBCs (p = 0.022) and ASA > II (p = 0.007). Patients with an ASA > II (p = 0.001), total operative time>140 min (p < 0.001) and Hct <36 (p = 0.006) were more likely to have a LOS >9 days. Male gender (p = 0.026), prior history of CHF (p = 0.024), LOS >9 days (p = 0.030) and >10% bodyweight loss in last 6 months before the procedure (p = 0.002) were predictors of 30-day mortality.
Patients with ASA grade > II, greater co-morbidity burden and prolonged operative times were likely to experience adverse events and have a longer length of stay. Surgeons can utilize this data to risk stratify patients so that appropriate pre-operative and post-operative medical optimization can take place.
骨盆/髋臼骨折会给社会带来严重的发病率、死亡率和经济成本。我们试图利用一个全国性的外科手术数据库，来评估骨盆/髋臼骨折手术固定后与住院时间延长、非回家出院目的地、30天不良事件及再入院相关的发病率及因素。
使用CPT编码（27215、27217、27218、27226、27227、27228）查询2011 - 2016年美国外科医师学会国家外科质量改进计划（ACS - NSQIP）数据库文件，以获取接受骨盆/髋臼骨折切开复位内固定术（ORIF）的患者信息。为确保分析纳入的是单纯骨盆/髋臼损伤的相关患者群体，接受相关骨折（椎体骨折、桡骨远端/尺骨骨折或股骨颈/髋部骨折）附加手术的患者被排除在分析之外。最终队列共纳入572例患者。严重不良事件（SAE）定义为：死亡、机械通气时间>48小时、非计划插管、中风、深静脉血栓形成、肺栓塞、心脏骤停、心肌梗死、急性肾衰竭、败血症、感染性休克、再次手术、深部手术部位感染（SSI）及器官/腔隙SSI。轻微不良事件（MAE）包括——伤口裂开、浅表SSI、尿路感染（UTI）及进行性肾功能不全。延长住院时间定义为>第75百分位数（>9天）。
与AAE相关的因素包括术前部分依赖的功能健康状况（p = 0.020）、输注≥1单位浓缩红细胞（p = 0.001）及ASA>II（p < 0.001）。发生SAE与术前充血性心力衰竭（CHF）[p = 0.005]、总手术时间>140分钟（p = 0.034）及术前血细胞比容<36（p = 0.003）相关。MAE与输注≥1单位浓缩红细胞（p = 0.022）及ASA>II（p = 0.007）相关。ASA>II（p = 0.001）、总手术时间>140分钟（p < 0.001）及血细胞比容<36（p = 0.006）的患者更有可能住院时间>9天。男性（p = 0.026）、既往CHF病史（p = 0.024）、住院时间>9天（p = 0.030）及术前最后6个月体重减轻>10%（p = 0.002）是30天死亡率的预测因素。
ASA分级>II、合并症负担较重及手术时间延长的患者可能会发生不良事件且住院时间更长。外科医生可利用这些数据对患者进行风险分层，以便进行适当的术前和术后医疗优化。
