与髓内钉固定相比，单纯肱骨骨干骨折切开复位内固定术后的住院时间和 30 天再入院率。

Length of stay and 30-day readmissions after isolated humeral shaft fracture open reduction and internal fixation compared to intramedullary nailing.

机构信息

Department of Orthopedic Surgery, Albert Einstein Medical Center, 5501 Old York Road, 19141 Philadelphia, PA, USA.

出版信息

Injury. 2020 Apr;51(4):942-946. doi: 10.1016/j.injury.2020.02.001. Epub 2020 Feb 3.

DOI:10.1016/j.injury.2020.02.001

PMID:32070557

Abstract

INTRODUCTION

Open reduction with internal fixation (ORIF) and intramedullary nailing (IMN) have similar union rates for treating humerus shaft fractures, but IMN leads to increased incidence of shoulder impingement and reoperation. The difference in 30-day readmission rate and length of stay (LOS) between these procedures is unknown. The objective of the study was to compare 30-day unplanned readmissions and length of stay between humeral shaft fractures fixed with either ORIF or IMN.

METHODS

The nationwide readmissions database (NRD) was queried for patients with humeral shaft fractures treated with ORIF or IMN between 2015-2016. IMN cases were propensity matched to ORIF cases based on demographic and co-morbid variables. Multivariable logistic regression determined if treatment modality was an independent risk factor for 30-day readmission or length of stay >3 days.

RESULTS

There were 406 patients treated with IMN matched to 406 patients treated with ORIF. The 30-day readmission rate was 6.4% for IMN and 4.9% for ORIF (p = 0.45), and the median LOS was 3 days for each group (p = 0.45). Congestive heart failure (CHF)(OR=2.7, p = 0.04), depression (OR=3.3, p = 0.0008), and electrolyte abnormality (OR=3.6, p = 0.0003) were independent risk factors for readmission. Older age (OR=1.02, p = 0.03), CHF (OR=2.4, p = 0.03), electrolyte abnormality (OR=2.6, p = 0.0001), obesity (OR=2.8, p<0.0001), Medicaid (OR=2.1, p = 0.04), discharge to a facility (OR = 5.2, p<0.0001), discharge with home health services (OR=2.4, p = 0.0003), and open fracture (OR=2.3, p = 0.01) were independent risk factors for LOS >3 days. Procedure (ORIF vs. IMN) was not a predictor of 30-day readmission or LOS >3 days.

CONCLUSION

Comorbid conditions are risk factors for 30-day readmission and increased LOS. Comorbidity, discharge disposition, and open fractures are risk factors for increased LOS. Treating humeral shaft fractures with either ORIF or IMN did not affect readmission or length of stay.

摘要

简介

切开复位内固定（ORIF）和髓内钉（IMN）治疗肱骨干骨折的愈合率相似，但 IMN 会增加肩峰撞击和再次手术的发生率。这两种方法在 30 天内再入院率和住院时间（LOS）方面的差异尚不清楚。本研究的目的是比较肱骨干骨折采用 ORIF 或 IMN 治疗后 30 天内的非计划性再入院率和住院时间。

方法

在全国再入院数据库（NRD）中查询 2015-2016 年接受 ORIF 或 IMN 治疗的肱骨干骨折患者。根据人口统计学和合并症变量，将 IMN 病例与 ORIF 病例进行倾向匹配。多变量逻辑回归确定治疗方式是否为 30 天内再入院或 LOS>3 天的独立危险因素。

结果

406 例 IMN 治疗患者与 406 例 ORIF 治疗患者相匹配。IMN 的 30 天再入院率为 6.4%，ORIF 为 4.9%（p=0.45），每组的中位 LOS 均为 3 天（p=0.45）。充血性心力衰竭（CHF）（OR=2.7，p=0.04）、抑郁症（OR=3.3，p=0.0008）和电解质异常（OR=3.6，p=0.0003）是再入院的独立危险因素。年龄较大（OR=1.02，p=0.03）、CHF（OR=2.4，p=0.03）、电解质异常（OR=2.6，p=0.0001）、肥胖（OR=2.8，p<0.0001）、医疗补助（OR=2.1，p=0.04）、医疗机构出院（OR=5.2，p<0.0001）、出院时伴有家庭健康服务（OR=2.4，p=0.0003）和开放性骨折（OR=2.3，p=0.01）是 LOS>3 天的独立危险因素。手术方式（ORIF 与 IMN）不是 30 天内再入院或 LOS>3 天的预测因素。