住院或门诊全肘关节置换术:来自美国外科医师学会国家手术质量改进计划的患者群体和30天手术结果的比较

IF 1.8 Q2 ORTHOPEDICS Clinics in Shoulder and Elbow Pub Date : 2023-12-01 Epub Date: 2023-11-23 DOI:10.5397/cise.2023.00486
David Momtaz, Farhan Ahmad, Aaron Singh, Emilie Song, Dean Slocum, Abdullah Ghali, Adham Abdelfattah
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引用次数: 0

摘要

背景:全肘关节置换术(TEA)并不常见,但发病率正在上升。传统的住院手术,越来越多的在门诊进行,与骨科手术的总体趋势一致。本研究的目的是比较住院和门诊手术的TEA结果。其次,我们试图确定预测手术环境的患者特征。方法:患者资料收集自美国外科医师学会国家质量改进计划。记录术前变量,包括患者人口统计学和合并症,并通过多变量回归评估基线差异,以预测手术环境。采用多因素回归比较术后30天内的并发症。结果:纳入了468例患者,303例住院患者和165例门诊患者。低白蛋白血症(优势比[OR], 2.5;P=0.029)、慢性阻塞性肺疾病(COPD)或肺炎史(or, 2.4;P=0.029),糖尿病(OR, 2.5;P=0.001)与住院患者TEA显著相关,任何并发症的发生率也较高(OR, 4.1;结论:住院TEA患者通常有更多的合并症,住院手术与并发症和不良出院的发生率相关。然而,我们发现门诊TEA的再手术率较高。我们的研究结果表明,尽管合并症负担较高的患者可能需要住院手术,但门诊TEA是安全的。证据水平:III。
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Inpatient or outpatient total elbow arthroplasty: a comparison of patient populations and 30-day surgical outcomes from the American College of Surgeons National Surgical Quality Improvement Program.

Background: Total elbow arthroplasty (TEA) is uncommon, but growing in incidence. Traditionally an inpatient operation, a growing number are performed outpatient, consistent with general trends in orthopedic surgery. The aim of this study was to compare TEA outcomes between inpatient and outpatient surgical settings. Secondarily, we sought to identify patient characteristics that predict the operative setting.

Methods: Patient data were collected from the American College of Surgeons National Quality Improvement Program. Preoperative variables, including patient demographics and comorbidities, were recorded, and baseline differences were assessed via multivariate regression to predict operative setting. Multivariate regression was also used to compare postoperative complications within 30 days.

Results: A total of 468 patients, 303 inpatient and 165 outpatient procedures, were identified for inclusion. Hypoalbuminemia (odds ratio [OR], 2.5; P=0.029), history of chronic obstructive pulmonary disorder or pneumonia (OR, 2.4; P=0.029), and diabetes mellitus (OR, 2.5; P=0.001) were significantly associated with inpatient TEA, as were greater odds of any complication (OR, 4.1; P<0.001) or adverse discharge (OR, 4.5; P<0.001) and decreased odds of reoperation (OR, 0.4; P=0.037).

Conclusions: Patients undergoing inpatient TEA are generally more comorbid, and inpatient surgery is associated with greater odds of complications and adverse discharge. However, we found higher rates of reoperation in outpatient TEA. Our findings suggest outpatient TEA is safe, although patients with a higher comorbidity burden may require inpatient surgery. Level of evidence: III.

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来源期刊
CiteScore
0.30
自引率
0.00%
发文量
55
审稿时长
15 weeks
期刊最新文献
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