Yeramosu Teja, Taitsman Lisa A, Kates Stephen L
Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Geriatr Orthop Surg Rehabil. 2025 Mar 17;16:21514593241291792. doi: 10.1177/21514593241291792. eCollection 2025.
Hip fractures are a major public health concern with a high mortality rate. Numerous risk factors for hip fracture have been identified, and efforts made to reduce complications and improve outcomes. This study aimed to assess recent trends in postoperative complications amongst early-career orthopaedic surgeons.
This retrospective study analyzed surgical cases submitted to the American Board of Orthopaedic Surgery (ABOS) for the Part II Oral Examination from 2013 to 2022. The database includes patient demographics and medical and surgical complications. Current Procedural Terminology codes reflecting operative fixation for hip fracture were selected. Data was split into two cohorts: 2013-2016 and 2017-2020. Univariate and multivariable logistic regression analyses were used to identify significant differences between cohorts.
49,418 cases were analyzed. Compared to 2013-2016, 2017-2020 had a reduction in the overall medical complication rate (-1.49%, = 0.0005), saw slight increases in congestive heart failure (+0.18%, = 0.049), renal failure (+0.37%, = 0.004), hypotension (+0.41%, = 0.0007), and hypoxia (+0.41%, = 0.0016). Minor decreases in myocardial infarction (-0.18%, = 0.047) and pneumonia (-0.34%, = 0.021) were noted. No differences occurred in confusion/delirium, deep vein thrombosis/pulmonary embolism, and mortality. There were no significant differences in overall surgical complications. The 90-day readmission rate increased with time (+1.17%, < 0.0001). Multivariable logistic regression identified a decrease in the likelihood of overall medical complications (Odds Ratio (OR): 0.92 [0.89, 0.96]; < 0.0001). Decreases were noted for the likelihood of myocardial infarction (OR: 0.81 [0.68, 0.98]; = 0.031), pneumonia (OR: 0.87 [0.78, 0.97]; = 0.013), fracture (OR: 0.80 [0.69, 0.92]; = 0.002), and recurrent/persistent/uncontrolled pain (OR: 0.72 [0.56, 0.92]; = 0.008). The likelihood of renal failure (OR: 1.18 [1.04, 1.34]; = 0.009) and readmission increased (OR: 1.14 [1.07, 1.20]; < 0.0001).
This study found little change in postoperative complication patterns over the past decade. These findings suggest that more efforts are needed to improve hip fracture care and outcomes.
髋部骨折是一个重大的公共卫生问题，死亡率很高。已确定了许多髋部骨折的风险因素，并努力减少并发症并改善治疗结果。本研究旨在评估早期职业骨科医生术后并发症的近期趋势。
这项回顾性研究分析了2013年至2022年提交给美国骨科手术委员会（ABOS）进行第二部分口试的手术病例。该数据库包括患者人口统计学以及医疗和手术并发症。选择反映髋部骨折手术固定的当前手术操作术语代码。数据分为两个队列：2013 - 2016年和2017 - 2020年。使用单变量和多变量逻辑回归分析来确定队列之间的显著差异。
共分析了49418例病例。与2013 - 2016年相比，2017 - 2020年总体医疗并发症发生率有所降低（-1.49%，P = 0.0005），充血性心力衰竭略有增加（+0.18%，P = 0.049），肾衰竭增加（+0.37%，P = 0.004），低血压增加（+0.41%，P = 0.0007），缺氧增加（+0.41%，P = 0.0016）。心肌梗死（-0.18%，P = 0.047）和肺炎（-0.34%，P = 0.021）略有下降。在意识模糊/谵妄、深静脉血栓形成/肺栓塞和死亡率方面没有差异。总体手术并发症方面没有显著差异。90天再入院率随时间增加（+1.17%，P < 0.0001）。多变量逻辑回归确定总体医疗并发症的可能性降低（比值比（OR）：0.92 [0.89, 0.96]；P < 0.0001）。心肌梗死（OR：0.81 [0.68, 0.98]；P = 0.031）、肺炎（OR：0.87 [0.78, 0.97]；P = 0.013）、骨折（OR：0.80 [0.69, 0.92]；P = 0.002）以及复发/持续/未控制疼痛（OR：0.72 [0.56, 0.92]；P = 0.008）的可能性均降低。肾衰竭（OR：1.18 [1.04, 1.34]；P = 0.009）和再入院的可能性增加（OR：1.14 [1.07, 1.20]；P < 0.0001）。
本研究发现过去十年术后并发症模式变化不大。这些发现表明需要做出更多努力来改善髋部骨折的护理和治疗结果。
