PDF(Pubmed)
Abstract：
UNASSIGNED: Identification of modifiable comorbid conditions in the preoperative period is important in optimizing outcomes. We evaluate the association between such risk factors and postoperative outcomes after upper extremity surgery using a national database.
UNASSIGNED: The National Surgical Quality Improvement Program (NSQIP) 2006-2016 database was used to identify patients undergoing an upper extremity principle surgical procedure using CPT codes. Modifiable risk factors were defined as smoking status, use of alcohol, obesity, recent loss of >10% body weight, malnutrition, and anemia. Outcomes included discharge destination, major complications, bleeding complications, unplanned re-operation, sepsis, and prolonged length of stay. Chi square and multivariable logistic regressions were used to identify significant predictors of outcomes. Significance was defined as P<0.01.
UNASSIGNED: After applying exclusion criteria, 53,780 patients were included in the final analysis. Preoperative malnutrition was significantly associated with non-routine discharge (OR=4.75), major complications (OR=7.27), bleeding complications (OR=7.43), unplanned re-operation (OR=2.44), sepsis (OR=10.22), and prolonged length of stay (OR=5.27). Anemia was associated with non-routine discharge (OR=2.67), bleeding complications (OR=13.27), and prolonged length of stay (OR=3.26). In patients who had a weight loss of greater than 10%, there was an increase of non-routine discharge (OR=2.77), major complications (OR=2.93), and sepsis (OR=3.7). Smoking, alcohol use, and obesity were not associated with these complications.
UNASSIGNED: Behavioral risk factors (smoking, alcohol use, and obesity) were not associated with increased complication rates. Malnutrition, weight loss, and anemia were associated with an increase in postoperative complication rates in patients undergoing upper limb orthopaedic procedures and should be addressed prior to surgery, suggesting nutrition labs should be part of the initial blood work.
UNASSIGNED: The National Surgical Quality Improvement Program (NSQIP) 2006-2016 database was used to identify patients undergoing an upper extremity principle surgical procedure using CPT codes. Modifiable risk factors were defined as smoking status, use of alcohol, obesity, recent loss of >10% body weight, malnutrition, and anemia. Outcomes included discharge destination, major complications, bleeding complications, unplanned re-operation, sepsis, and prolonged length of stay. Chi square and multivariable logistic regressions were used to identify significant predictors of outcomes. Significance was defined as P<0.01.
UNASSIGNED: After applying exclusion criteria, 53,780 patients were included in the final analysis. Preoperative malnutrition was significantly associated with non-routine discharge (OR=4.75), major complications (OR=7.27), bleeding complications (OR=7.43), unplanned re-operation (OR=2.44), sepsis (OR=10.22), and prolonged length of stay (OR=5.27). Anemia was associated with non-routine discharge (OR=2.67), bleeding complications (OR=13.27), and prolonged length of stay (OR=3.26). In patients who had a weight loss of greater than 10%, there was an increase of non-routine discharge (OR=2.77), major complications (OR=2.93), and sepsis (OR=3.7). Smoking, alcohol use, and obesity were not associated with these complications.
UNASSIGNED: Behavioral risk factors (smoking, alcohol use, and obesity) were not associated with increased complication rates. Malnutrition, weight loss, and anemia were associated with an increase in postoperative complication rates in patients undergoing upper limb orthopaedic procedures and should be addressed prior to surgery, suggesting nutrition labs should be part of the initial blood work.
摘要：
■在术前确定可改变的共病条件对于优化结局很重要。我们使用国家数据库评估这些危险因素与上肢手术后结果之间的关系。
■国家外科质量改进计划（NSQIP）2006-2016年数据库用于使用CPT代码识别接受上肢原则外科手术的患者。可改变的危险因素被定义为吸烟状况，使用酒精，肥胖，最近体重下降了10%以上，营养不良,和贫血。结果包括出院目的地，主要并发症,出血并发症,计划外的重新手术,脓毒症,并延长逗留时间。卡方和多变量逻辑回归用于确定结果的重要预测因子。显著性定义为P<0.01。
■应用排除标准后，最终分析包括53,780名患者。术前营养不良与非常规出院显著相关(OR=4.75),主要并发症（OR=7.27），出血并发症（OR=7.43），计划外再操作(OR=2.44)，脓毒症（OR=10.22），并延长住院时间（OR=5.27）。贫血与非常规出院相关(OR=2.67),出血并发症（OR=13.27），并延长住院时间（OR=3.26）。在体重减轻超过10%的患者中，非常规放电增加（OR=2.77），主要并发症（OR=2.93），和脓毒症（OR=3.7）。吸烟,酒精使用,肥胖与这些并发症无关.
■行为危险因素（吸烟，酒精使用,和肥胖）与并发症发生率增加无关。营养不良,减肥,贫血与上肢矫形外科手术患者术后并发症发生率增加有关，应在手术前解决。建议营养实验室应该是最初血液工作的一部分。
■国家外科质量改进计划（NSQIP）2006-2016年数据库用于使用CPT代码识别接受上肢原则外科手术的患者。可改变的危险因素被定义为吸烟状况，使用酒精，肥胖，最近体重下降了10%以上，营养不良,和贫血。结果包括出院目的地，主要并发症,出血并发症,计划外的重新手术,脓毒症,并延长逗留时间。卡方和多变量逻辑回归用于确定结果的重要预测因子。显著性定义为P<0.01。
■应用排除标准后，最终分析包括53,780名患者。术前营养不良与非常规出院显著相关(OR=4.75),主要并发症（OR=7.27），出血并发症（OR=7.43），计划外再操作(OR=2.44)，脓毒症（OR=10.22），并延长住院时间（OR=5.27）。贫血与非常规出院相关(OR=2.67),出血并发症（OR=13.27），并延长住院时间（OR=3.26）。在体重减轻超过10%的患者中，非常规放电增加（OR=2.77），主要并发症（OR=2.93），和脓毒症（OR=3.7）。吸烟,酒精使用,肥胖与这些并发症无关.
■行为危险因素（吸烟，酒精使用,和肥胖）与并发症发生率增加无关。营养不良,减肥,贫血与上肢矫形外科手术患者术后并发症发生率增加有关，应在手术前解决。建议营养实验室应该是最初血液工作的一部分。
