Rohrer Felix, Haddenbruch David, Noetzli Hubert, Gahl Brigitta, Limacher Andreas, Hermann Tanja, Bruegger Jan
Department of Internal Medicine, Sonnenhofspital, 3006, Bern, Switzerland.
Centre Hospitalier Universitaire Vaudois, CHUV, 1011, Lausanne, Switzerland.
Perioper Med (Lond). 2021 Dec 15;10(1):47. doi: 10.1186/s13741-021-00218-z.
No surgical intervention is without risk. Readmissions and reoperations after elective orthopedic surgery are common and are also stressful for the patient. It has been shown that a comprehensive ortho-medical co-management model decreases readmission rates in older patients suffering from hip fracture; but it is still unclear if this also applies to elective orthopedic surgery. The aim of the current study was to determine the proportion of unplanned readmissions or returns to operating room (for any reason) across a broad elective orthopedic population within 90 days after elective surgery. All cases took place in a tertiary care center using co-management care and were also assessed for risk factors leading to readmission or unplanned return to operating room (UROR).
In this observational study, 1295 patients undergoing elective orthopedic surgery between 2015 and 2017 at a tertiary care center in Switzerland were investigated. The proportion of reoperations and readmissions within 90 days was measured, and possible risk factors for reoperation or readmission were identified using logistic regression.
In our cohort, 3.2% (42 of 1295 patients) had an UROR or readmission. Sixteen patients were readmitted without requiring further surgery-nine of which due to medical and seven to surgical reasons. Patient-related factors associated with UROR and readmission were older age (67 vs. 60 years; p = 0.014), and American Society of Anesthesiologists physical status (ASA PS) score ≥ 3 (43% vs. 18%; p < 0.001). Surgery-related factors were: implantation of foreign material (62% vs. 33%; p < 0.001), duration of operation (76 min. vs. 60 min; p < 0.001), and spine surgery (57% vs. 17%; p < 0.001). Notably, only spine surgery was also found to be independent risk factor.
Rates of UROR during initial hospitalization and readmission were lower in the current study than described in the literature. However, several comorbidities and surgery-related risk factors were found to be associated with these events. Although no surgery is without risk, known threats should be reduced and every effort undertaken to minimize complications in high-risk populations. Further prospective controlled research is needed to investigate the potential benefits of a co-management model in elective orthopedic surgery.
任何外科手术都存在风险。择期骨科手术后的再次入院和再次手术很常见，对患者来说也很有压力。研究表明，综合的骨科 - 内科共同管理模式可降低老年髋部骨折患者的再入院率；但目前尚不清楚这是否也适用于择期骨科手术。本研究的目的是确定在择期手术后90天内，广泛的择期骨科患者中计划外再次入院或返回手术室（因任何原因）的比例。所有病例均发生在一家采用共同管理护理的三级医疗中心，并对导致再次入院或计划外返回手术室（UROR）的风险因素进行了评估。
在这项观察性研究中，对2015年至2017年期间在瑞士一家三级医疗中心接受择期骨科手术的1295例患者进行了调查。测量了90天内再次手术和再次入院的比例，并使用逻辑回归确定再次手术或再次入院的可能风险因素。
在我们的队列中，3.2%（1295例患者中的42例）发生了计划外返回手术室或再次入院。16例患者再次入院但无需进一步手术，其中9例是由于内科原因，7例是由于外科原因。与计划外返回手术室和再次入院相关的患者因素包括年龄较大（67岁对60岁；p = ），以及美国麻醉医师协会身体状况（ASA PS）评分≥3（43%对18%；p < ）。与手术相关的因素包括：植入异物（62%对33%；p < ）、手术时间（76分钟对60分钟；p < ）和脊柱手术（57%对17%；p < ）。值得注意的是，仅脊柱手术也被发现是独立的风险因素。
本研究中初次住院期间计划外返回手术室和再次入院的发生率低于文献报道。然而，发现一些合并症和与手术相关的风险因素与这些事件有关。虽然没有手术是没有风险的，但应减少已知的威胁，并尽一切努力将高危人群的并发症降至最低。需要进一步进行前瞻性对照研究，以调查共同管理模式在择期骨科手术中的潜在益处。
