Kreinces Jason, Lapow Justin, Feingold Jacob, Akinleye Oluwatoba, Spirollari Eris, Asprinio David E, Wellman David S
New York Medical College, School of Medicine, Valhalla, NY, USA.
Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA.
J Orthop. 2023 Oct 31;46:107-111. doi: 10.1016/j.jor.2023.10.030. eCollection 2023 Dec.
The systemic inflammatory response syndrome (SIRS) is a clinical reaction that can occur due to a variety of stimuli. Reamed intramedullary femoral nailing is a common orthopedic surgery that has been shown to induce SIRS. To date, no nationwide analyses have been performed to evaluate the incidence, risk factors, and economic burdens of SIRS following intramedullary femoral nailing for femoral shaft fractures. The objective of this study is to investigate the independent predictors, incidence, post-operative, and economic burden of SIRS among patients treated with intramedullary nailing for femoral shaft fractures.
We utilized the 2016-2019 National Inpatient Sample (NIS) to identify patients who underwent intramedullary femoral nailing and were diagnosed with non-infectious SIRS (NI-SIRS) based on ICD-10-CM coding. Identified patients who underwent intramedullary femoral nailing were dichotomized into SIRS and Non-SIRS groups to assess independent predictors of SIRS development, and to compare post-operative complications and costs.
A total of 65,240 patients with femur shaft fractures underwent IMFN, of which 665 (1.0 %) developed NI-SIRS. Patients with NI-SIRS had a higher incidence of laparotomy (OR = 13.97, p < 0.001), initial treatment with external fixation (OR = 1.845, p < 0.001), and late application of external fixation (OR = 4.884, p = 0.005). Routine discharge (OR = 0.491, p < 0.001) was less likely in patients with NI-SIRS. Length of stay (12.38 days vs 7.16 days, p < 0.001) and total charges ($278, 590 vs $145,118, p < 0.001) were both increased in patients with NI-SIRS.
NI-SIRS is associated with increasing injury severity and post-operative complications. Those that developed NI-SIRS experienced higher healthcare resource utilization. Risk factors associated with development of NI-SIRS warrant further investigation.
全身炎症反应综合征（SIRS）是一种可由多种刺激引发的临床反应。扩髓股骨髓内钉固定术是一种常见的骨科手术，已被证明可诱发SIRS。迄今为止，尚未进行全国性分析来评估股骨干骨折髓内钉固定术后SIRS的发生率、危险因素和经济负担。本研究的目的是调查股骨干骨折髓内钉固定术患者中SIRS的独立预测因素、发生率、术后情况及经济负担。
我们利用2016 - 2019年全国住院患者样本（NIS）来识别接受股骨髓内钉固定术且根据ICD - 10 - CM编码被诊断为非感染性SIRS（NI - SIRS）的患者。将识别出的接受股骨髓内钉固定术的患者分为SIRS组和非SIRS组，以评估SIRS发生的独立预测因素，并比较术后并发症和费用。
共有65240例股骨干骨折患者接受了髓内钉固定术，其中665例（1.0%）发生了NI - SIRS。NI - SIRS患者剖腹手术发生率更高（OR = 13.97，p < 0.001）、初始采用外固定治疗（OR = 1.845，p < 0.001）以及后期应用外固定（OR = 4.884，p = 0.005）。NI - SIRS患者常规出院的可能性较小（OR = 0.491，p < 0.001）。NI - SIRS患者的住院时间（12.38天对7.16天，p < 0.001）和总费用（278590美元对145118美元，p < 0.001）均增加。
NI - SIRS与损伤严重程度增加和术后并发症相关。发生NI - SIRS的患者医疗资源利用率更高。与NI - SIRS发生相关的危险因素值得进一步研究。
