背景:脂肪栓塞是一种危及生命的并发症,常发生在外伤患者身上。然而,脂肪栓塞的时间趋势和围手术期结局仍未得到充分研究.使用具有全国代表性的队列,我们旨在描述手术治疗创伤患者脂肪栓塞的时间趋势及其相关资源利用。
方法:使用2005年至2020年的全国住院患者样本,对所有在外伤后接受任何重大手术的患者(≥18岁)进行列表。将患者分为有脂肪栓塞的患者和没有脂肪栓塞的患者。多变量逻辑和线性回归用于评估脂肪栓塞与目标结果之间的关联。
结果:估计有10,600,000例住院,7,479例(0.07%)患者出现脂肪栓塞。与非脂肪栓塞队列相比,脂肪栓塞队列较年轻(55[26-79]vs69[49-82]岁,标准平均差=0.46),并且更有可能在高容量创伤中心接受治疗(42.9vs33.7%,标准平均差=0.19)。在学习期间,脂肪栓塞组的年死亡率和住院费用增加(nptrend<0.001).风险调整后,与其他患者相比,脂肪栓塞与更高的死亡率相关(校正比值比:2.65,95%置信区间:2.24~3.14).此外,脂肪栓塞与脑血管疾病几率增加有关,传染性,和肾脏并发症。
结论:在所有手术治疗的创伤患者中,那些发生脂肪栓塞的人死亡率增加,并发症发生率,逗留时间,和成本。有必要对脂肪栓塞的早期和准确识别进行优化,以减轻并发症并改善创伤患者的资源分配。
BACKGROUND: Fat embolism is a life-threatening complication often occurring in patients with traumatic injuries. However, temporal trends and perioperative outcomes of fat embolism remain understudied. Using a nationally representative cohort, we aimed to characterize temporal trends of fat embolism and its associated resource utilization in operatively managed trauma patients.
METHODS: All patients (≥18 years) undergoing any major operations after traumatic injuries were tabulated using the 2005 to 2020 National Inpatient Sample. Patients were stratified into those with fat embolism and those without. Multivariable logistic and linear regressions were developed to assess the association between fat embolism and outcomes of interest.
RESULTS: Of an estimated 10,600,000 hospitalizations, 7,479 (0.07%) patients had fat embolism. Compared to the non-fat embolism cohort, the fat embolism cohort was younger (55 [26-79] vs 69 [49-82] years, standard mean difference = 0.46) and more likely to receive treatment at a high-volume trauma center (42.9 vs 33.7%, standard mean difference = 0.19). Over the study period, there was an increase in annual mortality and hospitalization costs among the fat embolism group (nptrend <0.001). After risk adjustment, fat embolism was associated with greater odds of mortality (adjusted odds ratio: 2.65, 95% confidence interval: 2.24-3.14) compared to others. Additionally, fat embolism was associated with increased odds of cerebrovascular, infectious, and renal complications.
CONCLUSIONS: Among all operatively managed trauma patients, those who developed fat embolism had increased mortality, rates of complications, length of stay, and costs. Optimization of early and accurate identification of fat embolism is warranted to mitigate complications and improve resource allocation among trauma patients.