Is the time to revision surgery after peri-prosthetic fracture of the knee associated with increased rates of post-operative complications?
Is the time to revision surgery after peri-prosthetic fracture of the knee associated with increased rates of post-operative complications?
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DOI：
10.1016/j.artd.2019.05.002
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发表时间：
2019-09-01
影响因子：
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通讯作者：
Shah, Roshan P
中科院分区：
文献类型：
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作者：
Boddapati, Venkat;Held, Michael B;Shah, Roshan P
背景：本注册研究评估了30天的结果，包括并发症、住院时间（LOS）、输血和出院处置，作为膝关节假体周围骨折（PPF）翻修手术时间的函数。方法：我们使用2005-2016年国家外科质量改进计划注册表，比较入院后≤（加急）或> 24小时（非加急）手术的结果。使用双变量和多变量分析评估结果变量。结果：在484例接受翻修膝关节置换术治疗PPF的患者中，337例（77.9%）进行了加速手术，107例（22.1%）进行了非加速手术。非加急组平均手术时间为3.2天（范围0-11天）。非加速手术的患者更可能是老年人、女性和糖尿病患者，接受全身麻醉，具有较高的美国麻醉医师学会等级、依赖功能状态和较长的手术时间。在多因素分析中，非加速患者有更多的并发症（优势比[OR]， 2.35; P = 0.037）、手术部位感染（优势比[OR]， 12.87; P = 0.029）、尿路感染（优势比[OR]， 10.46; P = 0.048）、非居家出院（优势比[OR]， 4.27; P < 0.001）、需要输血（优势比[OR]， 4.53; P < 0.001）和较长的LOS（优势比为2.4天；P < 0.001）。死亡率差异无统计学意义（P = 0.352）。结论：非加速翻修手术治疗膝关节PPF的结果更差，特别是更多的手术部位和尿路感染，更长的LOS，需要血液制品，以及更多的急性护理机构出院。本注册研究不能评估不可避免的延迟的原因，如医疗优化和团队或植入物的可用性。证据水平：iii。
BACKGROUND: This registry study assesses 30-day outcomes, including complications, length of stay (LOS), transfusions, and discharge disposition, as a function of time to revision surgery for knee periprosthetic fracture (PPF).METHODS: We compared outcomes when surgery occurred ≤ (expedited) or > 24 hours (nonexpedited) after admission using the 2005-2016 National Surgical Quality Improvement Program registry. Outcome variables were assessed using bivariate and multivariate analyses.RESULTS: Of 484 patients undergoing revision knee arthroplasty for PPF, 337 (77.9%) had expedited surgery and 107 (22.1%) had nonexpedited surgery. The average time to surgery in the nonexpedited group was 3.2 days (range 0-11). Patients with nonexpedited surgery were more likely to be older, female, and diabetic, received general anesthesia, and had a higher American Society of Anesthesiologists class, dependent functional status, and longer operative time. On multivariate analysis, nonexpedited patients had more complications (odds ratio [OR], 2.35; P = 0.037), surgical site infections (OR, 12.87; P = 0.029), urinary tract infections (OR, 10.46; P = 0.048), nonhome discharge (OR, 4.27; P < 0.001), need for blood transfusion (OR, 4.53; P < 0.001), and longer LOS (2.4 days; P < 0.001). There was no difference in mortality (P = 0.352).CONCLUSIONS: Nonexpedited revision surgery for knee PPF had worse outcomes, specifically more surgical site and urinary tract infections, longer LOS, need for blood products, and more discharge to acute care facilities. This registry study cannot assess reasons for unavoidable delay, such as medical optimization and team or implant availability.LEVEL OF EVIDENCE: III.