Wilson Jacob M, Holzgrefe Russell E, Staley Christopher A, Karas Spero, Gottschalk Michael B, Wagner Eric R
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Shoulder Elbow. 2021 Feb;13(1):79-88. doi: 10.1177/1758573219876573. Epub 2019 Sep 26.
Total shoulder arthroplasty has been demonstrated to be an effective treatment for arthritis of the glenohumeral joint. Prior studies have identified longer operative times as a risk factor for complications after numerous types of procedures. We hypothesized that increased operative time, in 20-min intervals, would be associated with complications following total shoulder arthroplasty.
Patients undergoing total shoulder arthroplasty from 2006 to 2015 were identified from the ACS-NSQIP database. Patient demographic information, perioperative parameters, and 30-day outcomes were retrieved. Pearson's Chi-square test and multivariate Poisson regression with robust error variance were used to analyze the relationship of operative time and outcomes.
A total of 10,082 patients were included. Multivariate analysis revealed that for each increase in 20 min of operative time, there were significantly increased rates of any complication (relative risk (RR) 1.24, 95% confidence interval (CI) 1.19-1.26), anemia requiring transfusion (RR 1.33, 95%CI 1.26-1.4), peripheral nerve injury (RR 1.88, 95%CI 1.53-2.31), and urinary tract infection (RR 1.24, 95%CI 1.09-1.41).
This study indicates that increasing operative time confers increased risk for postoperative complications following total shoulder arthroplasty. We anticipate the results of this manuscript will be used for provider education, policy decision-making, and potentially to derive algorithms that can improve safety and efficiency in total shoulder arthroplasty.
III.
全肩关节置换术已被证明是治疗盂肱关节关节炎的有效方法。先前的研究已确定手术时间延长是多种手术术后并发症的一个风险因素。我们假设，以20分钟为间隔增加手术时间会与全肩关节置换术后的并发症相关。
从美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库中识别出2006年至2015年接受全肩关节置换术的患者。检索患者的人口统计学信息、围手术期参数和30天的结果。采用Pearson卡方检验和具有稳健误差方差的多变量泊松回归分析手术时间与结果之间的关系。
共纳入10082例患者。多变量分析显示，手术时间每增加20分钟，任何并发症（相对风险（RR）1.24，95%置信区间（CI）1.19-1.26）、需要输血的贫血（RR 1.33，95%CI 1.26-1.4）、周围神经损伤（RR 1.88，95%CI 1.53-2.31）和尿路感染（RR 1.24，95%CI 1.09-1.41）的发生率均显著增加。
本研究表明，全肩关节置换术后手术时间增加会使术后并发症风险增加。我们预计本文的结果将用于医务人员培训、政策决策，并可能用于推导可提高全肩关节置换术安全性和效率的算法。
III级。
