Subspecialty Fellowship Training Is Not Associated With Better Outcomes in Fixation of Low-Energy Femoral Neck Fractures-An Analysis of the Fixation Using Alternative Implants for the Treatment of Hip Fractures Database.
Subspecialty Fellowship Training Is Not Associated With Better Outcomes in Fixation of Low-Energy Femoral Neck Fractures-An Analysis of the Fixation Using Alternative Implants for the Treatment of Hip Fractures Database.
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DOI：
10.1097/bot.0000000000002264
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发表时间：
2022-04-01
影响因子：
2.3
通讯作者：
FAITH Investigators
中科院分区：
文献类型：
--
作者：
DeAngelis RD;Stein MK;Minutillo GT;Mehta NG;Schemitsch EH;Bzovsky S;Sprague S;Bhandari M;Swiontkowski M;Donegan DJ;Mehta S;FAITH Investigators
根据外科医生培训（创伤培训与非创伤培训），比较接受松质骨螺钉（CS）或滑动髋螺钉（SHS）固定的股骨颈骨折患者的再次手术风险。FAITH数据的回顾性审查。8个国家的81个中心。819例≥ 50岁的低能量髋关节骨折患者需要手术固定。在初始数据集中，患者被随机分配至CS或SHS组。主要结局是再次手术的风险。次要结局包括死亡、严重不良事件、影像学愈合、出院处置和术后使用非卧床器械。两个外科医生组之间的再次手术风险没有差异（p > 0.05）。接受骨科创伤外科医生治疗的患者更有可能超重/肥胖，并有严重的内科合并症（p < 0.05）。接受创伤研究金培训的外科医生治疗的患者发生严重不良事件的风险更高，放射学愈合的可能性更高，出院的几率更高（p < 0.05）。基于该数据，无论是否接受过研究员培训，低能量股骨颈骨折固定术的再次手术风险均等同。在创伤训练组中观察到的影像学愈合可能性较高，似乎没有重大临床意义，因为它不影响两组之间的再次手术风险。损伤前存在的患者特异性因素，如体型和医学合并症，可能是创伤骨科医生治疗的患者出院回家的几率较低和术后并发症风险较高的原因。预测等级II。有关证据等级的完整描述，请参见作者说明。
To compare risk of reoperation for femoral neck fracture patients undergoing fixation with cancellous screws (CS) or sliding hip screws (SHS) based on surgeon fellowship (trauma-fellowship-trained versus non-trauma-fellowship-trained). Retrospective review of FAITH data. Eighty-one centers across eight countries. 819 patients ≥ 50 years-old with low energy hip fractures requiring surgical fixation. Patients were randomized to CS or SHS in the initial dataset. The primary outcome was risk of reoperation. Secondary outcomes included death, serious adverse events, radiographic healing, discharge disposition, and use of ambulatory devices postoperatively. There was no difference in risk of reoperation between the two surgeon groups (p > 0.05). Patients treated by orthopaedic trauma surgeons were more likely to be overweight/obese and have major medical comorbidities (p < 0.05). There was a higher risk of serious adverse events, higher likelihood of radiographic healing, and higher odds of discharge to a facility for patients treated by trauma-fellowship-trained surgeons (p < 0.05). Based on this data, risk of reoperation for low energy femoral neck fracture fixation is equivalent regardless of fellowship training. The higher likelihood of radiographic healing noted in the trauma-trained group does not appear to have a major clinical implication as it did not affect risk of reoperation between the two groups. Patient-specific factors present pre-injury, such as body habitus and medical comorbidities, may account for the lower odds of discharge to home and higher risk of postoperative medical complications for patients treated by orthopaedic trauma surgeons. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.