全踝关节置换时的附加手术不会增加短期并发症风险：一项匹配队列分析
Additional Procedures at the Time of Total Ankle Replacement Do Not Increase Risk of Short-term Complications: A Matched Cohort Analysis.
作者信息
Peri Maria I, Whitaker Sarah, Cole Sarah, Anastasio Albert, Satalich James R, O'Neill Conor N, Patel Tejas T, Nunley James A, Easley Mark E, Schweitzer Karl M
机构信息
Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA.
出版信息
Foot Ankle Orthop. 2024 Aug 26;9(3):24730114241268150. doi: 10.1177/24730114241268150. eCollection 2024 Jul.
BACKGROUND
This retrospective cohort study compared short-term complication rates following total ankle arthroplasty (TAA), alone or with concomitant procedures. Secondary independent risk factors were also examined as they related to postoperative outcomes.
METHODS
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using () codes to identify patients who underwent TAA (27702) between 2010 to 2021. Patients were divided into cohorts based on the presence or absence of ancillary procedures. Propensity score matching was employed to account for demographic differences, and statistical analyses were performed to compare short-term complication rates between matched cohorts.
RESULTS
A total of 2225 patients were identified, with 1432 (64.4%) receiving TAA alone and 793 (35.6%) with ancillary procedure(s). After matching, 793 patients were included in each cohort. The ancillary cohort had longer operative times ( < .001) and length of hospital stay (LOS) ( < 0.001). Rates for extended LOS were significantly higher in the ancillary cohort than in the simple cohort ( = .01). No other complications varied significantly between cohorts, including the incidence of any adverse event (AAE). American Society of Anesthesiologists classification of 4 was found to be an independent risk factor for development of AAE (odds ratio [OR] = 1.091, = .04). Matched subgroup analysis excluding tendon lengthening as a concomitant procedure found that the ancillary cohort still had longer operative time ( < .001) and LOS ( < .05) than patients undergoing simple TAA.
CONCLUSION
Without significant difference in rates of AAE other than extended LOS, the relative safety of ancillary TAA appears similar to that of TAA alone. Such knowledge can help inform surgical decision-making and assuage safety concerns for patients requiring additional corrective procedures at the time of TAA.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
背景
这项回顾性队列研究比较了全踝关节置换术（TAA）单独进行或联合其他手术的短期并发症发生率。还研究了与术后结果相关的次要独立危险因素。
方法
使用（）编码查询美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）数据库，以识别2010年至2021年间接受TAA（27702）的患者。根据是否进行辅助手术将患者分为不同队列。采用倾向评分匹配来考虑人口统计学差异，并进行统计分析以比较匹配队列之间的短期并发症发生率。
结果
共识别出2225例患者，其中1432例（64.4%）仅接受TAA，793例（35.6%）接受了辅助手术。匹配后，每个队列纳入793例患者。辅助手术队列的手术时间更长（<0.001），住院时间（LOS）也更长（<0.001）。辅助手术队列中延长住院时间的发生率显著高于单纯手术队列（=0.01）。各队列之间的其他并发症差异均无统计学意义，包括任何不良事件（AAE）的发生率。美国麻醉医师协会4级分类被发现是发生AAE的独立危险因素（优势比[OR]=1.091，= .04）。排除肌腱延长作为伴随手术的匹配亚组分析发现，辅助手术队列的手术时间和LOS仍比单纯接受TAA的患者更长（<0.001）（<0.05）。
结论
除延长住院时间外，AAE发生率无显著差异，辅助TAA的相对安全性似乎与单纯TAA相似。这些知识有助于为手术决策提供参考，并缓解TAA时需要额外矫正手术的患者的安全担忧。
证据水平
III级，回顾性比较研究。
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