Zhong Jack, Crutchfield Connor R, Lee Nathan J, Mueller John, Ahmad Christopher, Trofa David, Lynch Thomas Sean
Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 622 W. 168th Street - PH 11, New York, NY 10032, United States.
Department of Orthopaedic Surgery, New York University Langone Health, 301 E. 17th Street, New York, NY 10010, United States.
J Hip Preserv Surg. 2024 Dec 25;12(1):54-64. doi: 10.1093/jhps/hnae038. eCollection 2025 Jan.
Overnight admission is a rare but major complication after hip arthroscopy (HA), and the paucity of data surrounding its causes limits patient education and quality of care. The purpose of this study was to identify risk factors for an unanticipated overnight admission after HA and assess for associated complications. This analysis queried the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes to identify hip arthroscopies from 2005 to 2017. Patient demographics, perioperative variables, and comorbidities were compared between ambulatory and nonambulatory patients [length of stay (LOS) ≥ 1] using bivariate analysis. Multivariate stepwise logistic regression then identified independent risk factors of adverse outcomes. Linear regression analyzed correlation of LOS with age, operative time, modified fragility index (mFI-5), and year of operation. A total of 2420 cases were included in this study with 400 (16.5%) overnight admissions. The mean subject age was 40 ± 13.9 years old (58.1% female). Admitted patients generally had higher American Society of Anesthesiologists (ASA) scores and a higher mFI-5 index. Multivariate logistic regression showed that mFI-5 > 0, bleeding disorders, operative time >1.5 h, and nongeneral anesthesia were independent risk factors for prolonged hospital stay. Patients aged 31-40 years had decreased risk of LOS ≥1. Nonambulatory surgery was associated with significantly increased risk for any complication, readmission, wound complication, and venous thromboembolism. This analysis demonstrates that operations >1.5 h and increased medical comorbidities predispose patients to greater risk of being admitted to the hospital after HA. Surgeons should consider these data to optimize controllable factors and patient selection to reduce the risk of postoperative admission.
过夜留院是髋关节镜检查（HA）后一种罕见但严重的并发症，而关于其病因的数据匮乏限制了患者教育和医疗质量。本研究的目的是确定HA后意外过夜留院的风险因素，并评估相关并发症。该分析使用现行手术操作术语代码查询美国外科医师学会国家外科质量改进计划数据库，以识别2005年至2017年的髋关节镜检查病例。使用双变量分析比较门诊患者和非门诊患者[住院时间（LOS）≥1天]的患者人口统计学、围手术期变量和合并症。然后，多变量逐步逻辑回归确定不良结局的独立风险因素。线性回归分析了LOS与年龄、手术时间、改良脆弱指数（mFI-5）和手术年份之间的相关性。本研究共纳入2420例病例，其中400例（16.5%）过夜留院。受试者的平均年龄为40±13.9岁（58.1%为女性）。留院患者的美国麻醉医师协会（ASA）评分和mFI-5指数通常较高。多变量逻辑回归显示，mFI-5>0、出血性疾病、手术时间>1.5小时和非全身麻醉是住院时间延长的独立风险因素。31至40岁的患者LOS≥1天的风险降低。非门诊手术与任何并发症、再次入院、伤口并发症和静脉血栓栓塞的风险显著增加相关。该分析表明，手术时间>1.5小时和医疗合并症增加使患者在HA后住院的风险更高。外科医生应考虑这些数据，以优化可控因素和患者选择，降低术后入院风险。
