社会人口学特征与开放性胫骨骨折患者手术及时性的关系。

IF 2.2 3区 医学 Q3 CRITICAL CARE MEDICINE Injury-International Journal of the Care of the Injured Pub Date : 2024-09-12 DOI:10.1016/j.injury.2024.111878
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引用次数: 0

摘要

背景:美国外科学院建议在胫骨开放性骨折发生后 24 小时内进行手术清创。目前尚不清楚这一建议的执行率如何,也不清楚导致手术延迟的因素有哪些:为了确定与开放性胫骨骨折手术延迟相关的特征,我们利用美国外科医生学会创伤质量改进计划 2017 年至 2021 年的数据进行了一项回顾性队列研究。研究纳入了因开放性胫骨骨折到创伤中心就诊的 18 岁及以上患者。采用分层回归模型确定患者与设施之间的关联:在 491 家创伤中心就诊的 24102 名患者中,66.3% 为白人,21.7% 为黑人,1.5% 为亚裔,1.1% 为美洲印第安人,10.6% 为其他种族。共有 15.8% 的人被认定为西班牙裔。患者多为男性(75.9%),有私人保险(47.6%)。在调整后的分析中,与白人患者相比,黑人和美国印第安人患者的等待时间分别长5.5%(CI 1.3%-9.9%)和17.8%(CI 2.2%-35.8%),在24小时内接受手术的几率降低(AOR 0.85,CI 0.8-0.9;AOR 0.69,CI 0.5-0.9)。女性患者的等待时间比男性患者长 6.5%(CI 3.0%-10.2%)。享受医疗补助的患者比享受私人保险的患者等待时间长 5.5 %(CI 1.2 %-9.9%)。更长的手术时间与年龄增加(p < 0.001)、受伤严重程度增加(p < 0.001)和出现精神改变(p < 0.001)有关:我们发现,黑人和美国印第安人患者、女性以及享受医疗补助的患者在开放性胫骨骨折的手术冲洗和清创方面需要等待更长的时间。为实现创伤护理的公平性,有必要实施注重健康公平的质量标准。
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Association of sociodemographic characteristics with the timeliness of surgery for patients with open tibial fractures

Background

The American College of Surgeons recommends operative debridement of open tibial fractures within 24 h of presentation. It is unknown what the compliance rates are with this recommendation and what factors contribute to delays to operation.

Methods

To determine the characteristics associated with delays to operation for open tibial fractures, we conducted a retrospective cohort study utilizing American College of Surgeons Trauma Quality Improvement Program data from 2017 to 2021. Individuals aged 18 and older presenting to a trauma center with an open tibial fracture were included. Associations were determined with a hierarchal regression model nesting patients within facilities.

Results

Of the 24,102 patients presenting to 491 trauma centers, 66.3 % identified as White, 21.7 % as Black, 1.5 % as Asian, 1.1 % as American Indian, and 10.6 % as Other race. In total, 15.8 % identified as Hispanic. Patients were most often men (75.9 %) and privately insured (47.6 %). The median time to OR was 10.2 h (IQR 4.4–17.7) with 84.6 % receiving surgery within 24 h. In adjusted analyses, Black and American Indian patients had 5.5 % (CI 1.3 %-9.9 %) and 17.8 % (CI 2.2 %-35.8 %) longer wait times, respectively, and a decreased odds of receiving surgery within 24 h (AOR 0.85, CI 0.8–0.9; AOR 0.69, CI 0.5–0.9) when compared to White patients. Female patients had 6.5 % (CI 3.0 %-10.2 %) longer wait times than men. Patients with Medicaid had 5.5 % (CI 1.2 %-9.9 %) longer wait times than those with private insurance. Greater time to OR was associated with increasing age (p < 0.001), increasing injury severity (p < 0.001), and the presence of altered mentation (p < 0.001).

Conclusion

We identified longer wait times to operative irrigation and debridement of open tibial fractures for Black and American Indian patients, women, and those with Medicaid. The implementation of health equity focused quality metrics may be necessary to achieve equity in trauma care.
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
期刊最新文献
Editorial Board Fracture-related infection blood-based biomarkers: Diagnostic strategies The value of current diagnostic techniques in the diagnosis of fracture-related infections: Serum markers, histology, and cultures Antimicrobial resistance: Biofilms, small colony variants, and intracellular bacteria In vivo models of infection: Large animals – Mini review on human-scale one-stage revision in a porcine osteomyelitis model
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