Goodman Avi D, Brodeur Peter, Kosinski Lindsay R, Cruz Aristides I, Akelman Edward, Gil Joseph A
Harvard University, Boston, MA, USA.
Warren Alpert Medical School of Brown University Department of Orthopaedics, Providence, RI, USA.
Hand (N Y). 2024 Jul 30:15589447241265518. doi: 10.1177/15589447241265518.
Distal radius fractures account for nearly 25% of fractures in adults, with a trend toward operative fixation. The objective of this study was to assess the relationship between surgeon and hospital volume with complications following distal radius fixation.
A retrospective study was performed using the New York Statewide Planning and Research Cooperative System database from 2009 to 2015. Outpatient claims were identified for distal radius fractures and surgery. The facility and surgeon's identifier were used to calculate annual procedure volume. The risk for infection, carpal tunnel surgery, and revision/hardware removal was analyzed, and Social Deprivation Index (SDI) was linked to each patient. Patient demographics and rate of complications were compared across hospital and physician volume.
A total of 14 748 patients were included, finding Federal and self-pay insurance associated with low-volume (LV) facility care and private insurance with high-volume (HV) facilities. The SDI for patients treated by LV surgeons and hospitals was significantly higher compared with HV providers. Low-volume facilities and surgeons had a higher 3-month risk of infection requiring reoperation. High-volume facilities were less likely to treat Hispanic patients, those with comorbidities, higher SDI, and with Federal or self-pay insurance.
Patients treated by LV surgeons and facilities had a higher risk of infection requiring surgery within 3 months than those treated by HV providers. Low-volume facilities were more likely to treat patients who were Hispanic, Federally insured, and with comorbidities and higher SDI than HV facilities, increasing their risk for disadvantaged care.
Level III.
桡骨远端骨折占成人骨折的近25%，并且有手术固定的趋势。本研究的目的是评估外科医生和医院手术量与桡骨远端固定术后并发症之间的关系。
利用纽约州全州规划与研究合作系统数据库进行一项回顾性研究，研究时间为2009年至2015年。确定桡骨远端骨折和手术的门诊索赔。使用医疗机构和外科医生的标识符来计算年度手术量。分析感染、腕管手术以及翻修/取出内固定装置的风险，并将社会剥夺指数（SDI）与每位患者相关联。比较不同医院和医生手术量下的患者人口统计学特征和并发症发生率。
共纳入14748例患者，发现联邦保险和自费保险与低手术量（LV）医疗机构的治疗相关，而私人保险与高手术量（HV）医疗机构相关。与高手术量提供者相比，由低手术量外科医生和医院治疗的患者的社会剥夺指数显著更高。低手术量的医疗机构和外科医生在3个月内发生需要再次手术的感染风险更高。高手术量的医疗机构治疗西班牙裔患者、患有合并症、社会剥夺指数较高以及有联邦保险或自费保险的患者的可能性较小。
与高手术量提供者治疗的患者相比，由低手术量外科医生和医疗机构治疗的患者在3个月内发生需要手术的感染风险更高。与高手术量医疗机构相比，低手术量医疗机构更有可能治疗西班牙裔、有联邦保险、患有合并症且社会剥夺指数较高的患者，增加了他们接受弱势治疗的风险。
三级。
