全踝关节置换术后早期并发症的预测因素
Factors Predictive of Early Complications Following Total Ankle Arthroplasty.
作者信息
Del Balso Christopher, Halai Mansur M, MacLeod Mark D, Sanders David W, Rahman Lawendy Abdel
机构信息
Department of Surgery, Division of Orthopaedic Surgery, London Health Sciences Centre-Victoria Hospital, Western University, London, Ontario, Canada.
Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
出版信息
Foot Ankle Orthop. 2022 Jun 14;7(2):24730114221102456. doi: 10.1177/24730114221102456. eCollection 2022 Apr.
BACKGROUND
The safety of outpatient total ankle arthroplasty (TAA), and factors predictive of early complications are poorly understood. The objective of this study was to determine the frequency of early complications in patients undergoing outpatient TAA compared to a matched inpatient TAA cohort. Factors predictive of early complications following TAA are elucidated.
METHODS
A retrospective review of prospectively collected data from the 2011-2018 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was performed. An unadjusted analysis comparing complication rates in outpatient, and inpatient TAA was performed followed by a propensity score-matched cohort analysis. A multivariate logistic regression model was then used to identify significant independent predictors for complications, reoperation, and readmission following TAA.
RESULTS
A total of 1487 patients (198 outpatient, 1289 inpatient) undergoing TAA were included in the study. Inpatient TAA was associated with increased 30-day readmission compared with outpatient TAA (3.54% vs 0.51%, = .032) in a matched cohort analysis. Thirty-eight (2.6%) patients had a minor complication, with 16 (1.1%) patients having a major complication after TAR. Nineteen (1.3%) patients underwent reoperation, and 42 (2.8%) patients were readmitted within 30 days of the index TAR. Multivariate analysis identified factors predictive of early complications to include length of stay (LOS) >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus.
CONCLUSION
From this relatively limited data set, outpatient TAA appears to be safe for management of end-stage ankle arthritis in select patients. Inpatient status was associated with an increased rate of 30-day readmission following TAA. Postoperative length of stay >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus were identified to be associated with early postoperative complications following TAA in this cohort.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
背景
门诊全踝关节置换术（TAA）的安全性以及早期并发症的预测因素尚不清楚。本研究的目的是确定与匹配的住院TAA队列相比，接受门诊TAA患者的早期并发症发生率。阐明TAA术后早期并发症的预测因素。
方法
对2011 - 2018年美国外科医师学会 - 国家外科质量改进计划（ACS - NSQIP）数据库中前瞻性收集的数据进行回顾性分析。首先进行未调整分析，比较门诊和住院TAA的并发症发生率，然后进行倾向评分匹配队列分析。接着使用多因素逻辑回归模型确定TAA术后并发症、再次手术和再入院的显著独立预测因素。
结果
本研究共纳入1487例行TAA的患者（198例门诊患者，1289例住院患者）。在匹配队列分析中，与门诊TAA相比，住院TAA与30天再入院率增加相关（3.54%对0.51%，P = 0.032）。38例（2.6%）患者发生轻微并发症，16例（1.1%）患者在TAR后发生严重并发症。19例（1.3%）患者接受了再次手术，42例（2.8%）患者在初次TAR后30天内再次入院。多因素分析确定早期并发症的预测因素包括住院时间（LOS）>2天、吸烟、高血压、出血性疾病和糖尿病。
结论
从这个相对有限的数据集中，门诊TAA似乎对特定患者的终末期踝关节炎治疗是安全的。住院状态与TAA术后30天再入院率增加相关。在该队列中，术后住院时间>2天、吸烟、高血压、出血性疾病和糖尿病与TAA术后早期并发症相关。
证据级别
III级，回顾性队列研究。
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