Is Lateral Femoral Nailing Associated With Increased Intensive Care Unit Days? A Propensity-Matched Analysis of 848 Cases
| Autor: | Nathan N OʼHara, Renan C. Castillo, Robert V OʼToole, G Bradley Reahl, Gerard P. Slobogean, Max Coale, Lyndsay M OʼHara |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Supine position Adolescent law.invention Intramedullary rod Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Trauma Centers law Fracture fixation Humans Medicine Orthopedics and Sports Medicine Propensity Score Retrospective Studies 030222 orthopedics business.industry 030208 emergency & critical care medicine Retrospective cohort study General Medicine Length of Stay Middle Aged Respiration Artificial Intensive care unit Confidence interval Fracture Fixation Intramedullary Surgery Intensive Care Units Propensity score matching Injury Severity Score Female business Femoral Fractures |
| Zdroj: | Journal of Orthopaedic Trauma. 32:39-42 |
| ISSN: | 0890-5339 |
| DOI: | 10.1097/bot.0000000000000999 |
| Popis: | Objective The purpose of this study is to determine if lateral patient position during femoral nailing is associated with increases in intensive care unit (ICU) length of stay (LOS) or ventilator days when compared with femoral nailing in a supine position. Design Retrospective cohort study. Setting Level 1 trauma center. Patients/participants Patients with femoral shaft fractures treated with intramedullary fixation were identified. Propensity matching was performed to minimize selection bias using factors thought to be associated with surgeon selection of supine nailing at our institution (Injury Severity Score, Abbreviated Injury Score brain, and bilateral fractures). After matching, 848 patients were included in the analysis. Intervention Femoral nailing in the lateral position compared with the supine position. Main outcome measurements Our primary outcome measure was ICU LOS. Ventilator days were the secondary outcome. Results Treating patients with femoral nailing in the lateral position was associated with a 1.88 days (95% confidence interval, 0.73-3.02; P = 0.001) reduction in ICU LOS in our adjusted model. Intramedullary nailing in the lateral position was associated with a 1.29 days (95% confidence interval, -0.12 to 2.69) decrease in postoperative time on a ventilator. However, this finding was not statistically significant (P = 0.07). Conclusion Lateral femoral nailing was associated with decreased ICU LOS (P = 0.001) even after accounting for selection bias using propensity score matching. Our data indicate that lateral femoral nailing is likely not associated with the increased risk of pulmonary complication. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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