Varagur Kaamya, Sullivan Janessa, Chiang Sarah N, Skolnick Gary B, Sacks Justin M, Christensen Joani M
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
Plast Reconstr Surg Glob Open. 2023 Oct 16;11(10):e5345. doi: 10.1097/GOX.0000000000005345. eCollection 2023 Oct.
Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries.
The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022. We collected demographics, comorbidities, injury information, interventions, and complications. Propensity score weighting was used to minimize confounding differences between those presenting on weekends (Sat-Sun) versus weekdays (Mon-Fri). Weighted regressions were used to examine differences in interventions by day of presentation. Multivariable weighted regressions accounting for differences in interventions received were used to examine whether weekend presentation was associated with amputation risk, complications, or functional deficits.
Ninety-five patients with 100 open extremity degloving injuries were included. In total, 39% of injuries were weekend-presenting. There was a higher rate of noninsulin-dependent diabetes among patients presenting on weekends ( = 0.03). Weekend-presenting injuries had higher median Injury Severity Scores ( = 0.04). Propensity-weighted regression analysis revealed differences in interventions received on weekends, including lower rates of pedicled and free flaps and bone graft, and increased rates of negative-pressure wound therapy ( ≤ 0.02). Multivariable regression analysis revealed weekend presentation was a significant independent risk factor for amputation of the affected extremity [odds ratio 2.27, 95% CI (1.01-5.33), = 0.05].
Weekend presentation may impact interventions received and amputation risk in patients presenting with open extremity degloving injuries.
在包括中风、心肌梗死和严重肢体缺血在内的紧急情况下，周末就诊与不良预后相关。我们研究在肢体脱套伤的治疗及预后中是否存在周末效应。
该队列包括2018年6月至2022年5月期间在一家一级创伤中心就诊的开放性肢体脱套伤成人患者。我们收集了人口统计学资料、合并症、损伤信息、干预措施及并发症。采用倾向得分加权法以尽量减少周末（周六至周日）就诊与工作日（周一至周五）就诊患者之间的混杂差异。采用加权回归分析来研究就诊日期与干预措施之间的差异。使用考虑了所接受干预措施差异的多变量加权回归分析来研究周末就诊是否与截肢风险、并发症或功能缺陷相关。
纳入了95例患者的100处开放性肢体脱套伤。总体而言，39%的损伤是在周末就诊时发现的。周末就诊患者中非胰岛素依赖型糖尿病的发生率更高（P = 0.03）。周末就诊的损伤其损伤严重程度评分中位数更高（P = 0.04）。倾向得分加权回归分析显示周末接受的干预措施存在差异，包括带蒂皮瓣和游离皮瓣以及骨移植的使用率较低，而负压伤口治疗的使用率增加（P≤0.02）。多变量回归分析显示，周末就诊是患侧肢体截肢的一个显著独立危险因素[比值比2.27，95%置信区间（1.01 - 5.33），P = 0.05]。
周末就诊可能会影响开放性肢体脱套伤患者接受的干预措施及截肢风险。
