Panton Zachary A, Ranson Rachel, DeBaun Malcolm, Suneja Nishant, Pean Christian, Fleming Mark
Orthopaedic Surgery, Geisel School of Medicine at Dartmouth College, Hanover, USA.
Orthopaedic Surgery, George Washington University Hospital, Washington D.C., USA.
Cureus. 2023 Jul 2;15(7):e41283. doi: 10.7759/cureus.41283. eCollection 2023 Jul.
Background Studies demonstrate that metabolic syndrome (MetS) negatively impacts surgical outcomes. This study sought to identify how metabolic syndrome affects outcomes after open reduction and internal fixation (ORIF) of traumatic pilon fractures. Methods Patients who underwent ORIF for pilon fractures from 2012 to 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with MetS were compared to non-MetS patients for rates of adverse events, prolonged stay, readmission, discharge location, and operative time in the 30-day postoperative period. All statistical analyses were conducted using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Paired student t-tests were used to assess continuous variables. Pearson's Chi-square and odds ratios were used for categorical variables. Results A total of 1,915 patients met this study's inclusion criteria, and 127 MetS patients were identified in the cohort. The MetS cohort was older (62.7 vs 49.5 years old, p-value <0.01), with a greater proportion of female patients (59.1% vs 50.2%, p=0.054). MetS patients experienced significantly higher rates of infectious complications (7.9% vs 3.9% OR 2.75 (CI 1.36-5.53), p=0.008), major adverse events (11% vs 4.3%, OR 2.79 (CI 1.53-5.09) p=0.002), and readmissions. MetS patients also had longer lengths of stay (7 days vs 3.8 days, p-value<0.001), and were more likely to be discharged to a non-home location (51.2% vs 19.5%, p-value<0.01, OR 4.32 (CI=3.0-6.24) p<0.001). Conclusion Patients with MetS have an increased risk of 30-day major complications, infection, readmissions, discharge to a non-home location, and prolonged operative time, and therefore warrant additional consideration for perioperative monitoring.
背景 研究表明，代谢综合征（MetS）会对手术结果产生负面影响。本研究旨在确定代谢综合征如何影响创伤性Pilon骨折切开复位内固定术（ORIF）后的结果。方法 在美国外科医师学会国家外科质量改进计划数据库中识别出2012年至2019年接受Pilon骨折ORIF手术的患者。将患有MetS的患者与未患MetS的患者在术后30天内的不良事件发生率、住院时间延长、再入院率、出院地点和手术时间进行比较。所有统计分析均使用SPSS 26.0版（IBM公司，美国纽约州阿蒙克）进行。配对学生t检验用于评估连续变量。Pearson卡方检验和比值比用于分类变量。结果 共有1915名患者符合本研究的纳入标准，队列中识别出127名MetS患者。MetS队列年龄更大（62.7岁对49.5岁，p值<0.01），女性患者比例更高（59.1%对50.2%，p = 0.054）。MetS患者的感染并发症发生率（7.9%对3.9%，OR 2.75（CI 1.36 - 5.53），p = 0.008）、主要不良事件发生率（11%对4.3%，OR 2.79（CI 1.53 - 5.09），p = 0.002）和再入院率显著更高。MetS患者的住院时间也更长（7天对3.8天，p值<0.001）,并且更有可能出院到非家庭地点（51.2%对19.5%，p值<0.01，OR 4.32（CI = 3.0 - 6.24），p<0.001）。结论 患有MetS的患者发生30天主要并发症、感染、再入院、出院到非家庭地点和手术时间延长的风险增加，因此在围手术期监测方面需要额外考虑。
