Luttwak Ruth, Ibelli Taylor J, Taub Peter J, Melamed Eitan, Wiser Itay
Division of Plastic and Reconstructive Surgery, Elmhurst Hospital Center, New York, New York, USA; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Injury. 2023 Apr 13. doi: 10.1016/j.injury.2023.04.008.
There is no consensus on which risk factors are most predictive for complications following open reduction internal fixation of distal radius fractures (ORIF-DRF) in an outpatient setting. This study is a complication risk analysis for ORIF-DRF in outpatient settings based on data obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).
A nested, case-control study, was conducted in ORIF-DRF cases performed in outpatient settings from 2013 to 2019 obtained from the ACS-NSQIP database. Cases with documented local or systemic complications were age and gender-matched in a 1:3 ratio. The association between patient and procedure-dependent risk factors for systemic and local complications in general and for different subpopulations was examined. Bivariate and multivariable analyses were performed to evaluate the association between risk factors and complications.
From a total of 18,324 ORIF-DRF, 349 cases with complications were identified and matched to 1047 Controls. Independent patient-related risk factors included a history of smoking, the American Society of Anesthesiologists (ASA) Physical Status Classification 3 and 4, and bleeding disorder. The intra-articular fracture with three or more fragments was found to be an independent risk factor of all procedure-related risk factors. History of smoking was found to be an independent risk factor for all gender populations, as well as for patients younger the 65 years old. For older patients (age ≥65) bleeding disorder was found to be an independent risk factor.
Complications of ORIF-DRF in outpatient settings have many risk factors. This study provides surgeons with specific risk factors for possible complications following ORIF-DRF.
对于门诊环境下桡骨远端骨折切开复位内固定术（ORIF-DRF）后哪些危险因素最能预测并发症，目前尚无共识。本研究基于从美国外科医师学会国家外科质量改进计划（ACS-NSQIP）获得的数据，对门诊环境下的ORIF-DRF进行并发症风险分析。
进行了一项巢式病例对照研究，研究对象为2013年至2019年在门诊进行的ORIF-DRF病例，数据来自ACS-NSQIP数据库。记录有局部或全身并发症的病例按1:3的比例进行年龄和性别匹配。研究了患者和手术相关危险因素与全身及局部并发症总体以及不同亚组之间的关联。进行了双变量和多变量分析以评估危险因素与并发症之间的关联。
在总共18324例ORIF-DRF病例中，识别出349例有并发症的病例，并与1047例对照进行匹配。独立的患者相关危险因素包括吸烟史、美国麻醉医师协会（ASA）身体状况分类3级和4级以及出血性疾病。发现有三个或更多碎片的关节内骨折是所有手术相关危险因素中的独立危险因素。吸烟史被发现是所有性别群体以及65岁以下患者的独立危险因素。对于老年患者（年龄≥65岁），出血性疾病是独立危险因素。
门诊环境下ORIF-DRF的并发症有许多危险因素。本研究为外科医生提供了ORIF-DRF后可能发生并发症的具体危险因素。
