Fassler Richelle, Muthusamy Nishanth, Yaramada Lekha, Ling Kenny, Komatsu David, Wang Edward D
Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, USA.
Medicine, Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, USA.
Cureus. 2024 Dec 30;16(12):e76632. doi: 10.7759/cureus.76632. eCollection 2024 Dec.
Introduction Clavicle open reduction internal fixation (ORIF) is an effective treatment for the surgical management of clavicle fractures. However, the literature surrounding the risk factors for readmission and reoperation following clavicle ORIF remains understudied. The purpose of this study is to investigate the specific risk factors for 30-day readmission and reoperation following clavicle ORIF. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all patients between 2015 and 2020 who underwent clavicle ORIF. Patients were divided into cohorts, both for readmission and reoperation status, after exclusion criteria. Bivariate logistic regression was used to identify patient demographics and comorbidities associated with readmission and reoperation. Multivariate logistic regression, adjusted for all significant patient demographics and comorbidities, was used to identify the risk factors independently associated with 30-day readmission and reoperation following clavicle ORIF. Results A total of 6,132 patients remained after exclusion criteria, with a readmission rate of 0.85% and a reoperation rate of 1.2%. On multivariate analysis, age 40-64 (odds ratio (OR) 2.79, 95% confidence interval (CI) 1.38-5.63; p = 0.004), age 65-74 (OR 3.07, 95% CI 1.00-9.41; p = 0.049), age ≥75 (OR 4.90, 95% CI 1.13-21.22; p = 0.033), American Society of Anesthesiologists (ASA) ≥3 (OR 2.71, 95% CI 1.26-5.37; p = 0.004), and smoking (OR 3.27, 95% CI 1.83-5.87; p < 0.001) were found to be independent risk factors for 30-day readmission. Additionally, age 40-64 years (OR 2.65, 95% CI 1.48-4.78; p = 0.001), age 65-74 (OR 3.51, 95% CI 1.44-8.57; p = 0.006), ASA ≥3 (OR 3.26, 95% CI 1.85-5.77; p < 0.001), and smoking (OR 2.84, 95% CI 1.74-4.65; p < 0.001) were found to be independent risk factors for 30-day reoperation. Conclusion Age ≥40 years, ASA ≥3, and smoking were identified as independent risk factors for 30-day readmission. Age 40-74 years, ASA ≥3, and smoking were identified as independent risk factors for 30-day reoperation. These results can guide physicians in preoperative patient counseling and management. Level of evidence Level III, retrospective cohort study.
引言
锁骨切开复位内固定术（ORIF）是治疗锁骨骨折的一种有效手术方法。然而，关于锁骨ORIF术后再入院和再次手术风险因素的相关文献仍研究不足。本研究旨在调查锁骨ORIF术后30天再入院和再次手术的具体风险因素。
方法
查询美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库中2015年至2020年间接受锁骨ORIF的所有患者。根据排除标准，将患者分为再入院和再次手术状态的队列。采用二元逻辑回归分析来确定与再入院和再次手术相关的患者人口统计学特征和合并症。在对所有显著的患者人口统计学特征和合并症进行校正后，采用多变量逻辑回归分析来确定与锁骨ORIF术后30天再入院和再次手术独立相关的风险因素。
结果
排除标准后共纳入6132例患者，再入院率为0.85%，再次手术率为1.2%。多变量分析显示，年龄40 - 64岁（比值比（OR）2.79，95%置信区间（CI）1.38 - 5.63；p = 0.004）、年龄65 - 74岁（OR 3.07，95% CI 1.00 - 9.41；p = 0.049）、年龄≥75岁（OR 4.90，95% CI 1.13 - 21.22；p = 0.033）、美国麻醉医师协会（ASA）分级≥3级（OR 2.71，95% CI 1.26 - 5.37；p = 0.004）以及吸烟（OR 3.27，95% CI 1.83 - 5.87；p < 0.001）是30天再入院的独立风险因素。此外，年龄40 - 64岁（OR 2.65，95% CI 1.48 - 4.78；p = 0.001）、年龄65 - 74岁（OR 3.51，95% CI 1.44 - 8.57；p = 0.006）、ASA分级≥3级（OR 3.26，95% CI 1.85 - 5.77；p < 0.001）以及吸烟（OR 2.84，95% CI 1.74 - 4.65；p < 0.001）是30天再次手术的独立风险因素。
结论
年龄≥40岁、ASA分级≥3级和吸烟被确定为30天再入院的独立风险因素。年龄40 - 74岁、ASA分级≥3级和吸烟被确定为30天再次手术的独立风险因素。这些结果可为医生在术前患者咨询和管理方面提供指导。
证据水平
III级，回顾性队列研究。
