Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Hand Surg Asian Pac Vol. 2023 Jun;28(3):307-314. doi: 10.1142/S2424835523500364. Epub 2023 May 5.
The objective of this study was to assess whether resident involvement in distal radius fracture open reduction internal fixation (ORIF) affect 30-day postoperative complication, hospital readmission, reoperation and operative time. A retrospective study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database by querying the Current Procedural Terminology (CPT) codes for distal radius fracture ORIF from 1 January 2011 to 31 December 2014. A final cohort of 5,693 adult patients who underwent distal radius fracture ORIF during the study period were included. Baseline patient demographics and comorbidities, intraoperative factors, including operative time and 30-day postoperative outcomes, including complications, readmission and reoperations, were collected. Bivariate statistical analyses were performed to identify variable associated with complication, readmission, reoperation and operative time. The significance level was adjusted using a Bonferroni correction as multiple comparisons were performed. In this study of 5,693 patients who underwent distal radius fracture ORIF, 66 patients had a complication, 85 patients were readmitted and 61 patients underwent reoperation within 30 days of surgery. Resident involvement in the surgery was not associated with 30-day postoperative complication, readmission or reoperation, but was associated with longer operative time. Moreover, 30-day postoperative complication was associated with older age, American Society of Anesthesiologists (ASA) classification, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hypertension and bleeding disorder. Thirty-day readmission was associated with older age, ASA classification, diabetes mellitus, COPD, hypertension, bleeding disorder and functional status. Thirty-day reoperation was associated with higher body mass index (BMI). Longer operative time was associated with younger age, male sex and the absence of bleeding disorder. Resident involvement in distal radius fracture ORIF is associated with longer operative time, but no difference in rates of episode-of-care adverse events. Patients may be reassured that resident involvement in distal radius fracture ORIF does not negatively impact short-term outcomes. Level IV (Therapeutic).
本研究旨在评估住院医师参与桡骨远端骨折切开复位内固定术（ORIF）是否会影响 30 天术后并发症、住院再入院、再次手术和手术时间。本研究采用美国外科医师学会（ACS）国家手术质量改进计划（NSQIP）数据库进行回顾性研究，通过查询 2011 年 1 月 1 日至 2014 年 12 月 31 日的手术操作分类（CPT）代码，检索桡骨远端骨折 ORIF 相关资料。最终纳入 5693 例成人桡骨远端骨折 ORIF 患者。收集患者的基线人口统计学特征和合并症、术中因素（包括手术时间）以及 30 天术后并发症、再入院和再次手术等结局。采用双变量统计分析来识别与并发症、再入院、再次手术和手术时间相关的变量。由于进行了多次比较，因此使用 Bonferroni 校正调整了显著性水平。在这项 5693 例桡骨远端骨折 ORIF 患者的研究中，有 66 例患者发生并发症，85 例患者术后 30 天内再入院，61 例患者再次手术。住院医师参与手术与 30 天术后并发症、再入院或再次手术无关，但与手术时间较长有关。此外，30 天术后并发症与年龄较大、美国麻醉医师协会（ASA）分级、慢性阻塞性肺疾病（COPD）、充血性心力衰竭（CHF）、高血压和出血性疾病有关。30 天再入院与年龄较大、ASA 分级、糖尿病、COPD、高血压、出血性疾病和功能状态有关。30 天再次手术与较高的体重指数（BMI）有关。手术时间较长与年龄较小、男性和无出血性疾病有关。住院医师参与桡骨远端骨折 ORIF 与手术时间较长有关，但在围手术期不良事件发生率方面无差异。患者可能会感到安心，即住院医师参与桡骨远端骨折 ORIF 不会对短期结果产生负面影响。IV 级（治疗）。
