Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Eur J Orthop Surg Traumatol. 2023 May;33(4):1043-1049. doi: 10.1007/s00590-022-03226-x. Epub 2022 Mar 24.
SARS-CoV-2 has had an extensive influence on orthopaedic surgery practice and has been associated with an increased risk of mortality. There is limited evidence of how this pertains to acute orthopaedic surgery with inpatient care.
A retrospective cohort study on traumatic fracture patients requiring inpatient care between February 25, 2020 and March 25, 2021 was conducted. Patients were grouped by perioperative SARS-CoV-2 infection, defined as a positive SARS-CoV-2 test from 7 days before to 7 days after orthopaedic surgery, and compared using linear regression and Cox proportional hazards model for primary outcome 30-day mortality and secondary outcome hospital length of stay.
In total, 5174 adults with a length of stay ≥ 48 h and an orthopaedic procedure due to a registered traumatic fracture were admitted from February 25, 2020 and discharged before March 26, 2021. Among the 5174 patients, 65% (3340/5174) were female, 22% (1146/5174) were 60-74 years and 56% (2897/5174) were 75 years or older. In total, 144 (3%) had a perioperative SARS-CoV-2 infection. Perioperative SARS-CoV-2 infection was associated with an increased 30-day mortality (aOR 4.19 [95% CI 2.67-6.43], p < 0.001). The median (IQR) length of stay after surgery was 13 days (IQR 6-21) for patients with, and 7 days (IQR 2-13) for patients without, perioperative SARS-CoV-2 infection.
Perioperative SARS-CoV-2 infection increased 30-day mortality risk and hospital length of stay for traumatic fracture patients requiring inpatient surgical care. Pre- and postoperative infection were both associated with similar increases in mortality risk.
SARS-CoV-2 对骨科手术实践产生了广泛影响，并与死亡率升高相关。关于伴有住院治疗的急性骨科手术，相关证据有限。
对 2020 年 2 月 25 日至 2021 年 3 月 25 日期间因创伤性骨折需要住院治疗的患者进行了回顾性队列研究。将患者按围手术期 SARS-CoV-2 感染分组，定义为骨科手术后 7 天内和手术前 7 天内 SARS-CoV-2 检测阳性，并使用线性回归和 Cox 比例风险模型比较主要结局 30 天死亡率和次要结局住院时间。
共有 5174 名成年患者因登记的创伤性骨折接受了骨科手术，住院时间≥48 小时，从 2020 年 2 月 25 日入院并于 2021 年 3 月 26 日之前出院。在 5174 名患者中，65%（3340/5174）为女性，22%（1146/5174）为 60-74 岁，56%（2897/5174）为 75 岁或以上。共有 144 名（3%）患者发生围手术期 SARS-CoV-2 感染。围手术期 SARS-CoV-2 感染与 30 天死亡率增加相关（调整后的比值比 4.19 [95%CI 2.67-6.43]，p<0.001）。发生围手术期 SARS-CoV-2 感染的患者术后中位（IQR）住院时间为 13 天（IQR 6-21），无围手术期 SARS-CoV-2 感染的患者为 7 天（IQR 2-13）。
围手术期 SARS-CoV-2 感染增加了需要住院手术治疗的创伤性骨折患者的 30 天死亡率风险和住院时间。术前和术后感染均与死亡率风险增加相似相关。
