评估手术前风险管理计划对全关节整形术后结果的影响:一项回顾性队列研究
Chloe Dlott1, Sebastian Romero2, Claire A Donnelley2
1Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
Arthroplasty today
|November 11, 2025
概括
关节置换手术的术前风险管理并没有持续改善结果,特别是对于具有高并发症或社会经济挑战的患者. 需要针对临床和社会因素的量身定制策略.
科学领域:
- 整形外科手术 整形外科手术
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 整关节整形术对于末期关节疾病是有效的,但对于患有并发症和边缘化群体的患者是有风险的.
- 术前风险管理计划旨在优化患者健康并减轻手术风险.
- 本研究研究了手术前优化计划对术后结果的影响,重点关注种族/族裔少数群体和公共保险患者.
研究的目的:
- 评估手术前风险管理计划对整体关节整形术的有效性.
- 评估该计划对术后结果的影响,包括停留时间,感染,再入院和急诊室访问.
- 通过种族/种族,保险类型和美国麻醉师协会的物理分类来分析分层的结果.
主要方法:
- 对2748名接受全关节或膝关节整形手术 (2019-2021) 的患者进行了回顾性队列研究.
- 1548名患者接受了手术前优化; 1200人遵循标准方案.
- 结果包括停留时间,假肢关节感染,30/90天再入院和急诊室访问,按患者特征分层.
主要成果:
- 优化的队列具有更高的查尔森并发症指数.
- 两组之间停留时间,再入院或整体急诊室访问没有显著差异.
- 黑人患者的90天术后急诊室利用率更高;严重疾病的医疗补助患者的感染率最高;优化没有改善高风险组的结果.
结论:
- 术前风险管理并没有持续改善结果,特别是对于具有高并发症或社会经济劣势的患者.
- 现有的优化策略可能无法充分解决脆弱患者群体的复杂需求.
- 需要量身定制的优化策略,将临床风险评估与健康的社会决定因素相结合.
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