Pitts Charles C, Levitt Eli B, Patch David A, Mihas Alexander K, Terrero Alfredo, Haendel Melissa A, Chute Christopher G, Ponce Brent A, Theiss Steven M, Spitler Clay A, Johnson Michael D
Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA.
Foot Ankle Orthop. 2022 Feb 24;7(1):24730114221077282. doi: 10.1177/24730114221077282. eCollection 2022 Jan.
The National COVID Cohort Collaborative (N3C) is an innovative approach to integrate real-world clinical observations into a harmonized database during the time of the COVID-19 pandemic when clinical research on ankle fracture surgery is otherwise mostly limited to expert opinion and research letters. The purpose of this manuscript is to introduce the largest cohort of US ankle fracture surgery patients to date with a comparison between lab-confirmed COVID-19-positive and COVID-19-negative.
A retrospective cohort of adults with ankle fracture surgery using data from the N3C database with patients undergoing surgery between March 2020 and June 2021. The database is an NIH-funded platform through which the harmonized clinical data from 46 sites is stored. Patient characteristics included body mass index, Charlson Comorbidity Index, and smoking status. Outcomes included 30-day mortality, overall mortality, surgical site infection (SSI), deep SSI, acute kidney injury, pulmonary embolism, deep vein thrombosis, sepsis, time to surgery, and length of stay. COVID-19-positive patients were compared to COVID-19-negative controls to investigate perioperative outcomes during the pandemic.
A total population of 8.4 million patient records was queried, identifying 4735 adults with ankle fracture surgery. The COVID-19-positive group (n=158, 3.3%) had significantly longer times to surgery (6.5 ± 6.6 vs 5.1 ± 5.5 days, = .001) and longer lengths of stay (8.3 ± 23.5 vs 4.3 ± 7.4 days, < .001), compared to the COVID-19-negative group. The COVID-19-positive group also had a higher rate of 30-day mortality.
Patients with ankle fracture surgery had longer time to surgery and prolonged hospitalizations in COVID-19-positive patients compared to those who tested negative (average delay was about 1 day and increased length of hospitalization was about 4 days). Few perioperative events were observed in either group. Overall, the risks associated with COVID-19 were measurable but not substantial.: Level III, retrospective cohort study.
国家新冠队列协作组（N3C）是一种创新方法，在新冠疫情期间将真实世界的临床观察结果整合到一个统一的数据库中，此时关于踝关节骨折手术的临床研究大多局限于专家意见和研究信函。本文的目的是介绍迄今为止美国最大的踝关节骨折手术患者队列，并对实验室确诊的新冠病毒阳性和阴性患者进行比较。
采用N3C数据库的数据进行一项回顾性队列研究，纳入2020年3月至2021年6月期间接受踝关节骨折手术的成年患者。该数据库是一个由美国国立卫生研究院资助的平台，存储了来自46个地点的统一临床数据。患者特征包括体重指数、查尔森合并症指数和吸烟状况。结局指标包括30天死亡率、总死亡率、手术部位感染（SSI）、深部SSI、急性肾损伤、肺栓塞、深静脉血栓形成、脓毒症、手术时间和住院时间。将新冠病毒阳性患者与新冠病毒阴性对照组进行比较，以研究疫情期间的围手术期结局。
共查询了840万份患者记录，确定了4735例接受踝关节骨折手术的成年患者。与新冠病毒阴性组相比，新冠病毒阳性组（n = 158，3.3%）的手术时间明显更长（6.5±6.6天对5.1±5.5天，P = 0.001），住院时间也更长（8.3±23.5天对4.3±7.4天，P < 0.001）。新冠病毒阳性组的30天死亡率也更高。
与检测阴性的患者相比，踝关节骨折手术患者中新冠病毒阳性患者的手术时间更长，住院时间延长（平均延迟约1天，住院时间增加约4天）。两组中观察到的围手术期事件均较少。总体而言，与新冠病毒相关的风险是可测量的，但并不严重。：三级，回顾性队列研究。
