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翻修全肩关节置换术后早期非计划再次手术的患者相关危险因素。

Patient-related risk factors for early unplanned reoperation following revision total shoulder arthroplasty.

作者信息

Alberto Ralph, Mehta Apoorva H, Gupta Puneet, Arciero Emily, Patel Kunj G, Trofa David P

机构信息

Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.

Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA.

出版信息

Shoulder Elbow. 2024 Apr 4:17585732241245377. doi: 10.1177/17585732241245377.

Abstract

PURPOSE

There has been an increase in the number of total shoulder arthroplasty (TSA) revisions performed as the number of primary surgeries increases rapidly. Revision procedures have a higher failure rate and there is a lack of understanding of patient risk factors for needing another repeat surgery following revision TSA.

METHODS

Revision patients were separated into two cohorts: those needing an unplanned reoperation and those that did not within 30 days following revision TSA. Multivariate logistic regression was performed to identify independent risk factors for an unplanned reoperation.

RESULTS

1909 revision TSA patients were included in the final analysis. Sixty-nine of these patients underwent an unplanned reoperation within 30 days and 1840 did not. Multivariate logistic regression analyses found an ASA class of III or IV, male sex, congestive heart failure, and inpatient setting to be independent risk factors.

CONCLUSION

3.6% of revision TSA patients require an unplanned reoperation within 30 days postoperatively. An ASA class of III or IV, male sex, congestive heart failure, and inpatient setting were found to be independent risk factors for early reoperation. Surgeons should be aware of these risks to improve preoperative patient optimization and guide shared decision making with patients considering revision.

摘要

目的

随着初次全肩关节置换术(TSA)手术数量迅速增加,TSA翻修手术的数量也在上升。翻修手术的失败率更高,并且对于TSA翻修术后需要再次进行手术的患者风险因素缺乏了解。

方法

将翻修患者分为两个队列:那些在TSA翻修术后30天内需要进行计划外再次手术的患者和不需要的患者。进行多因素逻辑回归分析以确定计划外再次手术的独立风险因素。

结果

1909例TSA翻修患者纳入最终分析。其中69例患者在30天内接受了计划外再次手术,1840例未接受。多因素逻辑回归分析发现美国麻醉医师协会(ASA)分级为III或IV级、男性、充血性心力衰竭和住院环境是独立风险因素。

结论

3.6%的TSA翻修患者在术后30天内需要进行计划外再次手术。ASA分级为III或IV级、男性、充血性心力衰竭和住院环境被发现是早期再次手术的独立风险因素。外科医生应了解这些风险,以改善术前患者的优化情况,并指导与考虑翻修手术的患者进行共同决策。

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