Biron Dustin R, Katakam Akhil, DalCortivo Robert L, Ahmed Irfan H, Vosbikian Michael M
Rutgers Health - New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, United States.
J Clin Orthop Trauma. 2024 Jun 25;54:102476. doi: 10.1016/j.jcot.2024.102476. eCollection 2024 Jul.
Distal radius fractures are among the most common orthopaedic injuries and are managed both surgically and non-surgically. To date, no study has examined the role hospital teaching status plays in the rates of surgical intervention.
The Nationwide Inpatient Sample (NIS) was queried for years 2003-2014. Patients with a distal radius fracture were identified using International Classification for Disease, Ninth Revision (ICD-9) disease codes. Surgical intervention was determined using ICD-9 procedure codes. Exclusion criteria were patients younger than age 18, polytrauma, open fractures, records with missing data, and records where the primary procedure was something other than open reduction of a radius or ulna fracture, closed reduction of a radius or ulna fracture, or blank. Chi-squared tests were run for demographic and socioeconomic data to identify significant variables. Significant variables were then included alongside hospital teaching status in a binomial logistic regression model. Significance was defined as < 0.05.
A weighted total of 98,831 patients were included in the study. Of those, 45,234 (45.8 %) were treated at teaching hospitals. Patients in teaching hospitals were more likely to be younger, male, non-white, and non-Medicare insured than non-teaching hospitals. Injuries were treated surgically in 64.6 % of total cases. Surgical intervention was more common in teaching hospitals than non-teaching hospitals (69.1 % vs. 60.8 %, < 0.01). After controlling for demographic and socioeconomic factors, patients at teaching hospitals were 31 % more likely to undergo surgical treatment than those at non-teaching hospitals. Other factors that were independently predictive of surgical treatment were age, race, and insurance type.
In the setting of distal radius fractures, teaching hospitals have higher rates of surgical intervention than non-teaching hospitals. These results suggest that the involvement of medical trainees may play a role in the surgical decision-making process.
桡骨远端骨折是最常见的骨科损伤之一，其治疗方式包括手术治疗和非手术治疗。迄今为止，尚无研究探讨医院教学状况在手术干预率中所起的作用。
查询2003年至2014年的全国住院患者样本（NIS）。使用国际疾病分类第九版（ICD-9）疾病编码确定桡骨远端骨折患者。通过ICD-9手术编码确定手术干预情况。排除标准为年龄小于18岁的患者、多发伤患者、开放性骨折患者、数据缺失的记录，以及主要手术不是桡骨或尺骨骨折切开复位、桡骨或尺骨骨折闭合复位或无手术记录的情况。对人口统计学和社会经济数据进行卡方检验以确定显著变量。然后将显著变量与医院教学状况一起纳入二项逻辑回归模型。显著性定义为P<0.05。
该研究共纳入加权后的98,831例患者。其中，45,234例（45.8%）在教学医院接受治疗。与非教学医院的患者相比，教学医院的患者更可能年龄较小、为男性、非白人且未参加医疗保险。64.6%的总病例接受了手术治疗。教学医院的手术干预比非教学医院更常见（69.1%对60.8%，P<0.01）。在控制了人口统计学和社会经济因素后，教学医院的患者接受手术治疗的可能性比非教学医院的患者高31%。其他独立预测手术治疗的因素包括年龄、种族和保险类型。
在桡骨远端骨折的情况下，教学医院的手术干预率高于非教学医院。这些结果表明，医学实习生的参与可能在手术决策过程中发挥作用。
