Copp Jonathan, Sivasundaram Lakshmanan, Abola Matthew V, Schell Adam, Trivedi Nikunj N, Ochenjele George
Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH; and.
Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
J Orthop Trauma. 2021 Jun 1;35(6):315-321. doi: 10.1097/BOT.0000000000001993.
To identify whether timing to surgery was related to major 30-day morbidity and mortality rates in periprosthetic hip and knee fractures [OTA/AO 3 (IV.3, V.3), OTA/AO 4 (V4)].
Retrospective database review.
Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
Patients in the NSQIP database with periprosthetic hip or knee fractures between 2007 and 2015.
Surgical management of periprosthetic hip and knee fractures including revision or open reduction internal fixation.
Major 30-day morbidity and mortality after operative treatment of periprosthetic hip or knee fractures.
A total of 1265 patients, mean age 72, including 883 periprosthetic hip and 382 periprosthetic fractures about the knee were reviewed. Delay in surgery greater than 72 hours is a risk factor for increased 30-day morbidity in periprosthetic hip and knee fractures [relative risk = 2.90 (95% confidence interval: 1.74-4.71); P-value ≤ 0.001] and risk factor for increased 30-day mortality [relative risk = 8.98 (95% confidence interval: 2.14-37.74); P-value = 0.003].
Using NSQIP database to analyze periprosthetic hip and knee fractures, delay to surgery is an independent risk factor for increased 30-day major morbidity and mortality when controlling for patient functional status and comorbidities. Although patient optimization and surgical planning are paramount, minimizing extended delays to surgery is a potentially modifiable risk factor in the geriatric periprosthetic lower extremity fracture patient.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定手术时机是否与人工髋关节和膝关节周围骨折（OTA/AO 3[IV.3，V.3]，OTA/AO 4[V4]）术后30天内的主要发病率和死亡率相关。
回顾性数据库分析。
参与美国外科医师学会国家外科质量改进计划（NSQIP）数据库的医院。
2007年至2015年间NSQIP数据库中患有人工髋关节或膝关节周围骨折的患者。
人工髋关节和膝关节周围骨折的手术治疗，包括翻修术或切开复位内固定术。
人工髋关节或膝关节周围骨折手术治疗后30天内的主要发病率和死亡率。
共纳入1265例患者，平均年龄72岁，其中包括883例人工髋关节周围骨折和382例人工膝关节周围骨折。手术延迟超过72小时是人工髋关节和膝关节周围骨折术后30天发病率增加的危险因素[相对危险度=2.90（95%置信区间：1.74-4.71）；P值≤0.001]，也是术后30天死亡率增加的危险因素[相对危险度=8.98（95%置信区间：2.14-37.74）；P值=0.003]。
利用NSQIP数据库分析人工髋关节和膝关节周围骨折，在控制患者功能状态和合并症的情况下，手术延迟是术后30天主要发病率和死亡率增加的独立危险因素。尽管优化患者情况和进行手术规划至关重要，但尽量减少手术的长期延迟是老年人工下肢骨折患者一个潜在的可改变的危险因素。
预后III级。有关证据水平的完整描述，请参阅作者指南。
