Department of Orthopedic Surgery, Austin Health, Heidelberg, Victoria 3084, Australia.
Intensive Care Unit, Hospital Sao Rafael, Salvador, & UNIME Medical School, Lauro de Freitas, Brazil.
Resuscitation. 2021 Feb;159:1-6. doi: 10.1016/j.resuscitation.2020.12.006. Epub 2020 Dec 24.
Patients undergoing orthopedic surgery are at risk of post-operative complications and needing Medical Emergency Team (MET) review. We assessed the frequency of, and associations with MET calls in orthopedic patients, and whether this was associated with increased in-hospital morbidity and mortality.
Retrospective cohort study of patients admitted over four years to a University teaching hospital using hospital administrative and MET call databases.
Amongst 6344 orthopedic patients, 55.8% were female, the median (IQR) age and Charlson comorbidity index were 66 years (47-79) and 3 (1-5), respectively. Overall, 54.5% of admissions were emergency admissions, 1130 (17.8%) were non-operative, and 605 (9.5%) patients received a MET call. The strongest independent associations with receiving a MET call was the operative procedure, especially hip and knee arthroplasty. Common MET triggers were hypotension (37.5%), tachycardia (25.0%) and tachypnoea (9.1%). Patients receiving a MET call were at increased risk of anemia, delirium, pressure injury, renal failure and wound infection. The mortality of patients who received a MET call was 9.8% compared with 0.8% for those who did not. After adjusting for pre-defined co-variates, requirement for a MET call was associated with an adjusted odd-ratio of 9.57 (95%CI 3.1-29.7) for risk of in-hospital death.
Approximately 10% of orthopedic patients received a MET call, which was most strongly associated with major hip and knee arthroplasty. Such patients are at increased risk of morbidity and in-hospital mortality. Further strategies are needed to more pro-actively manage at-risk orthopedic patients.
接受骨科手术的患者有发生术后并发症和需要医疗应急团队（MET）评估的风险。我们评估了骨科患者 MET 呼叫的频率和相关因素，以及这是否与住院期间发病率和死亡率的增加有关。
这是一项对四年内在一所大学教学医院住院的患者进行的回顾性队列研究，使用医院管理和 MET 呼叫数据库。
在 6344 名骨科患者中，55.8%为女性，中位（四分位距）年龄和 Charlson 合并症指数分别为 66 岁（47-79）和 3（1-5）。总体而言，54.5%的入院为急症入院，1130 例（17.8%）为非手术，605 例（9.5%）患者接受了 MET 呼叫。与接受 MET 呼叫最相关的独立因素是手术程序，尤其是髋关节和膝关节置换术。常见的 MET 触发因素包括低血压（37.5%）、心动过速（25.0%）和呼吸急促（9.1%）。接受 MET 呼叫的患者发生贫血、谵妄、压疮、肾衰竭和伤口感染的风险增加。接受 MET 呼叫的患者死亡率为 9.8%，而未接受 MET 呼叫的患者死亡率为 0.8%。在调整了预先定义的协变量后，需要 MET 呼叫与住院期间死亡的调整比值比（OR）相关，为 9.57（95%CI 3.1-29.7）。
大约 10%的骨科患者接受了 MET 呼叫，这与主要的髋关节和膝关节置换术关系最密切。此类患者的发病率和住院死亡率增加。需要进一步制定策略，更积极地管理有风险的骨科患者。
