Identifying Perioperative Risk factors for Ninety Days Mortality, Reoperation and Length of Stay in Orthopedic Surgery: Risk Evaluation in Orthopedic Surgery
Translated title
Identifikation af perioperative risiko faktorer for 90 dages mortalitet, reoperation og indlæggelsestid indenfor ortopædkirurgi: Risiko evaluering i orthopædkirurgi
Author
Kjeldsen, Jesper Lütkemeyer
Term
4. term
Publication year
2015
Submitted on
2015-05-29
Pages
16
Abstract
Formål: Nogle patient-, operations- og systemfaktorer påvirker sandsynligvis dødelighed, indlæggelsestid og behovet for en ny operation, men viden er ikke fuldstændig. Denne undersøgelse havde til formål at finde både kendte og nye risikofaktorer, der kan forudsige disse udfald hos ortopædkirurgiske patienter på Aalborg Universitetshospital. Metode: Vi screenede alle ortopædkirurgiske indlæggelser fra 1. august til 31. oktober 2014 og inkluderede patienter, der blev opereret og kunne følges i 3 måneder (663 ud af 970). Journaldata omfattede bl.a. køn, alder, BMI, indlæggelsestype (akut/elektiv), Charlsons komorbiditetsindeks (et mål for samlet sygdomsbyrde), diagnose (hoftefraktur/anden ortopædisk diagnose), tid til operation, operationstid, ordineret rehabiliteringsplan, tidlig rehabilitering, komorbiditeter samt udfald: 90-dages dødelighed, indlæggelsestid og reoperation. Udfald blev analyseret med regressionsmodeller. Resultater: Højere 90-dages dødelighed var forbundet med højere alder, Charlson-score over 3 og tidligere apopleksi; at have en ordineret rehabiliteringsplan var forbundet med lavere 90-dages dødelighed. Længere indlæggelsestid var forbundet med hoftefraktur, længere operationstid, højere alder og diabetes. Reoperation var forbundet med elektiv indlæggelse, depression og nyreinsufficiens. Konklusion: En høj komorbiditetsbyrde (Charlson > 3), højere alder og tidligere apopleksi kan hjælpe med at identificere patienter med øget risiko for død inden for 90 dage, mens en ordineret rehabiliteringsplan kan være forbundet med lavere risiko. Hoftefraktur, lange operationer og diabetes peger på længere indlæggelser, og depression eller nyreinsufficiens kan indikere øget risiko for reoperation.
Purpose: Some patient, surgical and system factors likely influence death, length of stay and the need for another operation, but evidence is incomplete. This study aimed to identify established and new risk factors that can predict these outcomes in orthopedic surgery patients at Aalborg University Hospital. Methods: We screened all orthopedic admissions from 1 August to 31 October 2014 and included patients who underwent surgery and could be followed for 3 months (663 of 970). From electronic records we collected sex, age, BMI, admission type (emergency/elective), Charlson Comorbidity Index (a measure of overall disease burden), diagnosis (hip fracture/other), time to surgery, operation time, prescribed rehabilitation plan, early rehabilitation, comorbidities, and outcomes: 90-day mortality, length of stay and reoperation. Outcomes were analyzed with regression models. Results: Higher 90-day mortality was associated with older age, a Charlson score above 3 and a history of stroke; having a prescribed rehabilitation plan was associated with lower 90-day mortality. Longer hospital stays were associated with hip fracture, longer operation time, older age and diabetes. Reoperation was associated with elective admission, depression and kidney insufficiency. Conclusion: A high comorbidity burden (Charlson > 3), older age and previous stroke may help flag patients at higher risk of death within 90 days, whereas having a rehabilitation plan may be linked to lower risk. Hip fracture, long operations and diabetes point to longer stays, and depression or kidney insufficiency may indicate a higher risk of reoperation.
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