背景:手术时间推迟,在骨科创伤的情况下,众所周知,与较高的发病率和死亡率有关,住院时间延长,以及总成本的相关上涨。入院后至少3天的手术时间延迟与标准手术后并发症的风险升高相关。非病理性,肱骨干骨折.据我们所知,尚不清楚病理性肱骨骨折是否存在同样的关联.这项研究的主要目的是确定危险因素,包括患者特征,合并症,和术后并发症,这与病理性肱骨骨折后手术时间的延迟有关。
方法:使用美国外科医师学会国家外科质量改进计划(ACSNSQIP)数据库查询2015年至2021年6年期间所有接受病理性肱骨骨折手术治疗的患者。手术后30天内报告术后并发症。手术延迟时间定义为从入院到手术≥2天。我们确定了总共248名患者,39.9%(n=99)的患者手术时间推迟。对所有显着相关变量进行校正的多变量逻辑回归用于确定病理性肱骨骨折手术时间延迟的预测因素。
结果:与手术时间延迟显著相关的患者特征为ASA分级≥3(p=0.016),依赖功能状态(p=0.041),充血性心力衰竭(p=0.008)。在调整了所有显著相关的患者变量后,与延迟手术时间独立相关的患者特征是非家庭出院(OR:2.93,95%CI1.53-5.63;p=0.001)和住院时间延长(OR:2.00,95%CI1.06-3.77;p=0.033).
结论:至少2天的手术时间延迟与非家庭出院和术后住院时间延长独立相关。在控制基线患者特征和合并症后,手术时间的延迟与病理性肱骨骨折手术治疗后30天并发症的增加无关.这与标准相反,非病理性肱骨骨折,手术时间的延迟与术后并发症的风险增加有关。
方法:回顾性队列比较;预后研究。
BACKGROUND: Delayed time to surgery, in the case of orthopedic trauma, is well known to be associated with higher morbidity and mortality, an extended duration of hospitalization, and an associated rise in overall cost. Delayed time to surgery of at least 3 days following hospital admission is associated with elevated risk of complications following surgery for a standard, non-pathologic, humeral shaft fracture. To our knowledge, it is unknown whether the same association is present for pathologic humerus fractures. The primary objective of this study was to identify risk factors, including patient characteristics, comorbidities, and postoperative complications, that are associated with delayed time to surgery following pathologic humeral fracture.
METHODS: All patients undergoing surgical management of pathologic humerus fractures across a 6-year period from 2015 to 2021 were queried using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Postoperative complications were reported within 30 days of procedure. Delayed time to surgery was defined by ≥ 2 days from hospital admission to surgery. We identified a total of 248 patients, and 39.9% (n = 99) of patients had delayed time to surgery. Multivariate logistic regression adjusted for all significantly associated variables was employed to identify predictors of delayed time to surgery for pathologic humerus fractures.
RESULTS: The characteristics of patients significantly associated with delayed time to surgery were ASA classification ≥ 3 (p = 0.016), dependent functional status (p = 0.041), and congestive heart failure (p = 0.008). After adjusting for all significantly associated patient variables, the characteristics of patients independently associated with delayed time to surgery were non-home discharge (OR: 2.93, 95% CI 1.53-5.63; p = 0.001) and extended length of stay (OR: 2.00, 95% CI 1.06-3.77; p = 0.033).
CONCLUSIONS: Delayed time to surgery of at least 2 days was independently associated with non-home discharge and extended postoperative length of stay. After controlling for baseline patient characteristics and comorbidities, delayed time to surgery was not independently associated with increased 30-day complications after surgical treatment of pathologic humeral fractures. This is in contrast to standard, non-pathologic humerus fractures in which delayed time to surgery is associated with an increased risk of postoperative complications.
METHODS: Retrospective Cohort Comparison; Prognosis Study.