Lans Jonathan, Beagles Clay B, Watkins Ian T, Lechtig Aron, Garg Rohit, Chen Neal C
Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and.
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Orthop Trauma. 2025 Jan 1;39(1):22-27. doi: 10.1097/BOT.0000000000002925.
This study aimed to determine whether outpatient upper extremity fracture surgery was associated with increased postoperative emergency department (ED) visits and identify related risk factors.
Retrospective cohort.
This multicenter study was conducted within a single academic institution, encompassing two Level 1, two Level 2, and one Level 3 trauma centers.
All patients >18 years of age who underwent upper extremity fracture surgery from 2015 to 2021 were included.
Risk factors for postoperative ED visit that were investigated included age, sex, tobacco use, alcohol abuse, psychiatric diagnosis, Elixhauser comorbidity score, race, location of upper extremity fracture, surgical setting (inpatient vs. outpatient), upper extremity block, surgical specialty, and Area Deprivation Index. Variables with a P < 0.1 in bivariate analysis were included in a multivariable logistic regression to determine factors associated with a postoperative ED visit at 30 and 90 days.
A total of 6315 patients with an average age of 51 ± 19 years were identified of whom 52% were women and 65% had outpatient surgery. Postoperatively, 188 patients (3.0%) presented to the ED within 30 days and 304 (4.8%) presented within 90 days. Thirty-seven percent of ED visits were directly related to the procedure, most commonly for pain (20%), cast issues (4.3%), and swelling (3.9%). At 30 days postoperatively, 2.8% of patients who underwent surgery in an outpatient setting and 3.4% of those who underwent inpatient surgery returned to the ED, with these rates increased to 4.4% and 5.6%, respectively, by 90 days. In multivariable analysis, outpatient surgery (odds ratio [OR]: 1.5, P = 0.030), tobacco use (OR: 2.1, P < 0.001), higher Elixhauser comorbidity scores (OR: 1.2, P < 0.001), non-White race (OR: 1.9, P < 0.001), elbow fractures (OR: 1.8, P = 0.016), and hand fractures (OR: 1.6, P = 0.046) were associated with 30-day ED visits.
Outpatient surgery was associated with increased rate of 30-day ED visits. Patients who smoke, had increased number of comorbidities, or were non-White presented to the ED more frequently.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在确定门诊上肢骨折手术是否与术后急诊就诊次数增加相关，并确定相关危险因素。
回顾性队列研究。
本多中心研究在单一学术机构内进行，涵盖两个一级、两个二级和一个三级创伤中心。
纳入2015年至2021年期间接受上肢骨折手术的所有18岁以上患者。
调查的术后急诊就诊危险因素包括年龄、性别、吸烟、酗酒、精神科诊断、埃利克斯豪泽共病评分、种族、上肢骨折部位、手术环境（住院 vs. 门诊）、上肢阻滞、手术专科和地区贫困指数。双变量分析中P < 0.1的变量纳入多变量逻辑回归，以确定与术后30天和90天急诊就诊相关的因素。
共确定6315例患者，平均年龄51±19岁，其中52%为女性，65%接受门诊手术。术后，188例患者（3.0%）在30天内前往急诊，304例（4.8%）在90天内前往急诊。37%的急诊就诊与手术直接相关，最常见的是疼痛（20%）、石膏问题（4.3%）和肿胀（3.9%）。术后30天，门诊手术患者中有2.8%、住院手术患者中有3.4%返回急诊，到90天时，这些比例分别增至4.4%和5.6%。在多变量分析中，门诊手术（比值比[OR]：1.5，P = 0.030）、吸烟（OR：2.1，P < 0.001）、较高的埃利克斯豪泽共病评分（OR：1.2，P < 0.001）、非白人种族（OR：1.9，P < 0.001）、肘部骨折（OR：1.8，P = 0.016）和手部骨折（OR：1.6，P = 0.046）与30天急诊就诊相关。
门诊手术与30天急诊就诊率增加相关。吸烟、共病数量增加或非白人的患者更频繁地前往急诊。
预后III级。有关证据水平的完整描述，请参阅作者指南。
