Kapilow Jaclyn, Ahn Junho, Gallaway Kathryn, Sorich Megan
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Geriatr Orthop Surg Rehabil. 2021 Jan 24;12:2151459320987699. doi: 10.1177/2151459320987699. eCollection 2021.
To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture.
Retrospective database review.
The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States.
PATIENTS/PARTICIPANTS: NSQIP patients over 65 years of age with patella fractures.
Surgical fixation of patella fracture including extensor mechanism repair.
Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications.
1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V.
Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes.
Prognostic level III.
报告髌骨骨折手术老年患者延长住院时间、转至其他机构以及术后并发症的发生率和危险因素。
回顾性数据库分析。
美国外科医师学会国家外科质量改进计划（NSQIP）收集了美国600家医院的数据。
患者/参与者：年龄超过65岁的NSQIP髌骨骨折患者。
髌骨骨折手术固定，包括伸肌机制修复。
延长住院时间、转至其他机构以及术后30天并发症。
1721例患者纳入研究。平均年龄74.9岁。358例（20.8%）为男性。122例（7.1%）住院时间超过7天。与延长住院时间相关的因素包括既往肾衰竭、急诊手术需求以及入院至手术时间超过24小时。640例（37.2%）患者术后转至其他机构。转至其他机构与年龄>77岁、肥胖、贫血、血小板减少、术前全身炎症反应综合征（SIRS）以及Charlson合并症指数（CCI）>0.5相关。从家中入院降低了转至其他机构的几率。该人群最常见的术后并发症为非计划再入院（3.4%）、非计划再次手术（2.7%）、手术部位感染（1.1%）、死亡率（1.0%）、静脉血栓栓塞（0.8%）和伤口裂开（0.2%）。并发症发生率随贫血和美国麻醉医师协会（ASA）分级IV - V级增加。
接受髌骨骨折手术干预的老年患者在术后30天内有延长住院时间、转至其他机构、非计划再入院或再次手术以及手术部位并发症的高风险。本研究强调了与不良事件相关的可改变和不可改变的危险因素。早期识别这些因素可在围手术期进行密切监测和多学科干预以改善预后。
预后III级。
