Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Duke University School of Medicine, Durham, NC, USA.
Injury. 2024 Nov;55(11):111883. doi: 10.1016/j.injury.2024.111883. Epub 2024 Sep 18.
Midshaft clavicle fractures are often subject to increased complications when treated nonoperatively, so surgical treatment with open reduction and internal fixation (ORIF) is a favored alternative. Despite safer outcomes, adverse events such as surgical site infections may still persist, particularly in the presence of certain patient characteristics. The objective of this study was to determine risk factors for and the frequency of adverse events following ORIF for clavicle fractures.
A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database from 2012 to 2021 identified patients undergoing isolated ORIF for clavicle fractures. Patient demographics and 30-day complications were collected. Bivariate analyses with a student's t-test or chi-square test were used to identify possible predictor variables for either AAE or SSI, and demographic metrics with P < 0.2 were included in a multivariable regression model. Multivariable analyses identified significant independent patient risk factors for any adverse event (AAE) or SSI within 30-days of surgery. Adjusted odds ratios were reported for each variable included in the model. Statistical significance was set a prior at P < 0.05.
The 6,753 selected patients who underwent ORIF for clavicle fractures between 2012 and 2021 were 38.1 ± 15.3 years of age, BMI 26.2 ± 4.9 kg m, and 77.3 % male. Of this cohort, 88.4 % received treatment on an outpatient basis. Postoperative adverse events were experienced by 128 (1.9 %) patients within 30 days of surgery, and SSI were prevalent in 0.77 % of patients, followed by wound dehiscence in 0.12 % of patients. After controlling for patient demographics and comorbidities, notable risk factors for adverse events included current smoking status (OR=2.036; P < 0.001) and patient age (OR=1.025; P < 0.001). Outpatient status (OR=0.528; P = 0.004) was protective.
The present study noted significantly increased risk of postoperative adverse events in older patients, as well as patients who smoke. Outpatient setting was significantly protective for adverse events. These findings help to provide further clinical context to guide surgical decision making and inform surgeons on current risks and outcomes.
非手术治疗锁骨中段骨折常导致并发症增加，因此切开复位内固定 (ORIF) 的手术治疗是一种更受欢迎的选择。尽管手术结果更安全，但仍可能存在手术部位感染等不良事件，特别是在存在某些患者特征的情况下。本研究的目的是确定 ORIF 治疗锁骨骨折后不良事件的危险因素和频率。
对 2012 年至 2021 年国家手术质量改进计划 (NSQIP) 数据库进行回顾性分析，确定接受单纯 ORIF 治疗锁骨骨折的患者。收集患者人口统计学资料和 30 天并发症。使用学生 t 检验或卡方检验进行单变量分析，以确定可能与 AAE 或 SSI 相关的预测变量，且 P<0.2 的人口统计学指标纳入多变量回归模型。多变量分析确定了手术 30 天内发生任何不良事件 (AAE) 或 SSI 的显著独立患者危险因素。报告了模型中每个变量的调整后优势比。统计显著性设为 P<0.05。
2012 年至 2021 年间，6753 例接受 ORIF 治疗锁骨骨折的患者年龄为 38.1±15.3 岁，BMI 为 26.2±4.9kgm，77.3%为男性。该队列中，88.4%的患者在门诊接受治疗。术后 30 天内有 128 例（1.9%）患者发生术后不良事件，其中 0.77%的患者发生手术部位感染，0.12%的患者发生伤口裂开。在控制患者人口统计学和合并症后，不良事件的显著危险因素包括当前吸烟状态（OR=2.036；P<0.001）和患者年龄（OR=1.025；P<0.001）。门诊状态（OR=0.528；P=0.004）具有保护作用。
本研究发现，老年患者和吸烟患者术后发生不良事件的风险显著增加。门诊设置对不良事件有显著的保护作用。这些发现有助于为手术决策提供进一步的临床背景，并告知外科医生当前的风险和结果。
