University Orthopedics, Providence, RI, USA.
Brown University, Providence, RI, USA.
Hand (N Y). 2022 May;17(3):426-431. doi: 10.1177/1558944720939201. Epub 2020 Jul 15.
Hand surgeons in the United States commonly perform ligament reconstruction and tendon interposition (LRTI) to address debilitating thumb carpometacarpal arthritis. The objective of this investigation was to examine the characteristics that place patients at risk for unanticipated inpatient admission after a planned outpatient LRTI. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) datasets from years 2009 to 2016 were used to identify patients with a primary Current Procedural Terminology code for LRTI (25445, 25447). Only outpatient, nonemergent, and elective procedures were considered. Univariable and multivariable regression were used to determine risk factors and postoperative complications associated with increased likelihood of unanticipated admission, defined as length of initial hospital stay greater than 0 days. Statistical significance was set at < .05. Of 3966 patients who underwent outpatient LRTI, 134 (3.4%) had unplanned admission. On multivariable regression, age ≥ 65 years (odds ratio [OR] = 1.50), white race (OR = 4.44), and chronic steroid use (OR = 2.42) were significant predictors of unplanned admission. History of smoking, obesity, hypertension, diabetes, American Society of Anesthesiologists classification, and anesthesia method were not associated with admission. Patients who had unplanned admission had increased rate of reoperation (2.5% vs 0.3%) compared with nonadmitted patients. There was no difference in rate of postoperative infection, deep vein thrombosis, wound dehiscence, or 30-day mortality. Age ≥ 65 years, chronic steroid use, and white race were significant predictors of unplanned admission following LRTI. Identifying patients with these characteristics will be critical in risk adjusting the anticipated cost of the episode of care in outpatient LRTI.
美国的手外科医生通常会进行韧带重建和肌腱间置术（LRTI）来治疗致残性拇指腕掌关节炎。本研究旨在探讨哪些特征会使接受计划门诊 LRTI 的患者在术后有意外住院的风险。研究使用了美国外科医师学会国家手术质量改进计划（ACS-NSQIP）2009 年至 2016 年的数据，以确定接受 LRTI 主要当前操作术语代码（25445、25447）的患者。仅考虑门诊、非紧急和选择性手术。使用单变量和多变量回归来确定与意外入院风险增加相关的危险因素和术后并发症，意外入院定义为初始住院时间大于 0 天。统计学意义设定为 <.05。在 3966 例接受门诊 LRTI 的患者中，有 134 例（3.4%）发生了计划外入院。多变量回归分析显示，年龄≥65 岁（优势比[OR] = 1.50）、白种人（OR = 4.44）和慢性类固醇使用（OR = 2.42）是计划外入院的显著预测因素。吸烟史、肥胖、高血压、糖尿病、美国麻醉医师协会分类和麻醉方法与入院无关。与未入院患者相比，计划外入院患者的再次手术率更高（2.5% vs 0.3%）。术后感染、深静脉血栓形成、伤口裂开或 30 天死亡率无差异。年龄≥65 岁、慢性类固醇使用和白种人是 LRTI 后意外入院的显著预测因素。识别具有这些特征的患者将是在门诊 LRTI 中调整预期护理费用风险的关键。
