大型学术医疗中心骨科重叠手术后短期患者结局评估。

Assessment of Short-Term Patient Outcomes Following Overlapping Orthopaedic Surgery at a Large Academic Medical Center.

机构信息

Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

McKenna EpiLog Program in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania.

出版信息

J Bone Joint Surg Am. 2020 Apr 15;102(8):654-663. doi: 10.2106/JBJS.19.00554.

DOI:10.2106/JBJS.19.00554

PMID:32058352

Abstract

BACKGROUND

Overlapping surgery is a long-standing practice that has not been well studied. The aim of this study was to assess whether overlapping surgery is associated with untoward outcomes for orthopaedic patients.

METHODS

Coarsened exact matching was used to assess the impact of overlap on outcomes among elective orthopaedic surgical interventions (n = 18,316) over 2 years (2014 and 2015) at 1 health-care system. Overlap was categorized as any overlap, and subcategories of exclusively beginning overlap and exclusively end overlap. Study subjects were matched on the Charlson comorbidity index score, duration of surgery, surgical costs, body mass index, length of stay, payer, and race, among others. Serious unanticipated events were studied.

RESULTS

A total of 3,395 patients had any overlap and were matched (a match rate of 90.8% of 3,738). For beginning and end overlap, matched groups were created, with a match rate of 95.2% of 1043 and 94.7% of 863, respectively. Among matched patients, any overlap did not predict an unanticipated return to surgery at 30 days (8.2% for any overlap and 8.3% for no overlap; p = 0.922) or 90 days (14.1% and 14.1%, respectively; p = 1.000). Patients who had surgery with any overlap demonstrated no difference compared with controls with respect to reoperation, readmission, or emergency room (ER) visits at 30 or 90 days (a reoperation rate of 3.1% and 3.2%, respectively [p = 0.884] at 30 days and 4.2% and 3.5% [p = 0.173] at 90 days; a readmission rate of 10.3% and 11.0% [p = 0.352] at 30 days and 5.5% and 5.2% [p = 0.570] at 90 days; and an ER visit rate of 5.2% and 4.6% [p = 0.276] at 30 days and 4.8% and 4.3% [p = 0.304] at 90 days). Patients with surgical overlap showed reduced mortality compared with controls during follow-up (1.8% and 2.6%, respectively; p = 0.029). Patients with beginning and/or end overlap had a similar lack of association with serious unanticipated events; however, patients with end overlap showed an increased unexpected rate of return to the operating room after reoperation at 90 days (13.3% versus 9.7%; p = 0.015).

CONCLUSIONS

Nonconcurrent overlapping surgery was not associated with adverse outcomes in a large, matched orthopaedic surgery population across 1 academic health system.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

重叠手术是一种由来已久的做法，但尚未得到充分研究。本研究旨在评估重叠手术是否与骨科患者的不良结果有关。

方法

使用粗化精确匹配来评估重叠手术对 1 个医疗系统（2014 年和 2015 年）2 年内（18316 例择期骨科手术干预）的结果的影响。重叠分为任何重叠，以及专门开始重叠和专门结束重叠的亚类。研究对象根据 Charlson 合并症指数评分、手术持续时间、手术费用、体重指数、住院时间、付款人和种族等进行匹配。研究了严重意外事件。

结果

共有 3395 名患者有任何重叠并进行了匹配（匹配率为 3738 名中的 90.8%）。对于开始和结束重叠，分别创建了匹配组，匹配率为 1043 名中的 95.2%和 863 名中的 94.7%。在匹配的患者中，任何重叠在 30 天（任何重叠的 8.2%和无重叠的 8.3%；p=0.922）或 90 天（分别为 14.1%和 14.1%；p=1.000）时均未预测到意外再次手术。与对照组相比，任何重叠手术的患者在 30 或 90 天时的再次手术、再入院或急诊就诊（分别为 30 天时的 3.1%和 3.2%[p=0.884]，90 天时的 4.2%和 3.5%[p=0.173]；再入院率分别为 10.3%和 11.0%[p=0.352]，90 天时的 5.5%和 5.2%[p=0.570]；急诊就诊率分别为 5.2%和 4.6%[p=0.276]，90 天时的 4.8%和 4.3%[p=0.304]）。在随访期间，有手术重叠的患者与对照组相比，死亡率较低（分别为 1.8%和 2.6%；p=0.029）。开始和/或结束重叠的患者与严重意外事件之间也没有明显关联；然而，结束重叠的患者在 90 天时再次手术后的意外返回手术室的发生率更高（13.3%比 9.7%；p=0.015）。