术前长期使用类固醇与肱骨头骨折切开复位内固定术后并发症的风险相关。
Preoperative chronic steroid use as a risk factor for complications following open reduction internal fixation for proximal humerus fracture.
机构信息
Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA.
Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA.
出版信息
Eur J Orthop Surg Traumatol. 2024 Aug;34(6):3193-3199. doi: 10.1007/s00590-024-04047-w. Epub 2024 Jul 24.
PURPOSE
The primary objective of this study was to investigate the association between preoperative chronic steroid use and postoperative complications following open reduction internal fixation (ORIF) for proximal humerus fractures (PHF).
METHODS
The American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for all patients who underwent PHF ORIF between 2015 and 2021. A total of 6,273 patients were included in this study, of which 3.4% (n = 212) were in the chronic steroid use cohort. Patient characteristics including demographics, comorbidities, and 30-day postoperative complications after PHF ORIF were collected. Bivariate logistic regression and multivariate logistic regression analysis, adjusted for all significantly associated variables, was conducted to investigate the relationship between preoperative chronic steroid use and postoperative complications.
RESULTS
Chronic steroid use was significantly associated with age ≥ 75 (p < 0.001), male gender (p =0.006), dependent functional status (p = 0.008), American Society of Anesthesiologist (ASA) ≥ 3 (p < 0.001), CHF (p = 0.007), hypertension (p < 0.001), COPD (p < 0.001), bleeding disorder (p = 0.007), ascites (p = 0.040), disseminated cancer (p< 0.001), and systemic sepsis (p < 0.001). After adjusting for all significantly associated variables, chronic steroid use was independently associated with major complication (OR 1.60, 95% CI 1.06-2.43; p = 0.026), and non-home discharge (OR 1.05, 95% CI 1.01-1.08; p = 0.014).
CONCLUSION
Preoperative chronic steroid use is associated with increasing rate of postoperative complications following PHF ORIF. Better understanding and characterizing chronic steroid use as a preoperative risk factor can aid physicians in risk stratification to reduce rates of postoperative complications following PHF ORIF.
LEVEL OF EVIDENCE
III. Retrospective Cohort Comparison; Prognosis Study.
目的
本研究的主要目的是探讨术前长期使用类固醇与肱骨头骨折切开复位内固定术（ORIF）后术后并发症之间的关系。
方法
检索美国外科医师学院国家外科质量改进计划（ACS-NSQIP）数据库，获取 2015 年至 2021 年间所有接受 PHF ORIF 的患者数据。本研究共纳入 6273 例患者，其中慢性类固醇使用组占 3.4%（n=212）。收集患者特征，包括人口统计学、合并症以及 PHF ORIF 后 30 天的术后并发症。采用二变量逻辑回归和多变量逻辑回归分析，调整所有显著相关变量，探讨术前慢性类固醇使用与术后并发症之间的关系。
结果
慢性类固醇使用与年龄≥75 岁（p<0.001）、男性（p=0.006）、依赖功能状态（p=0.008）、美国麻醉医师协会（ASA）≥3 级（p<0.001）、充血性心力衰竭（CHF）（p=0.007）、高血压（p<0.001）、慢性阻塞性肺疾病（COPD）（p<0.001）、出血性疾病（p=0.007）、腹水（p=0.040）、播散性癌症（p<0.001）和全身败血症（p<0.001）显著相关。在调整所有显著相关变量后，慢性类固醇使用与主要并发症独立相关（OR 1.60，95%CI 1.06-2.43；p=0.026），与非家庭出院独立相关（OR 1.05，95%CI 1.01-1.08；p=0.014）。
结论
术前长期使用类固醇与肱骨头骨折切开复位内固定术后并发症发生率增加有关。更好地了解和描述类固醇作为术前危险因素的作用，可以帮助医生进行风险分层，以降低 PHF ORIF 后术后并发症的发生率。
证据水平
III.回顾性队列比较；预后研究。
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