Abstract：
BACKGROUND:A 10-point Surgical Apgar Score, based on patients' estimated blood loss, lowest heart rate, and lowest mean arterial pressure during surgery, was developed to rate patients' outcomes in general and vascular surgery but has not been tested for patients having orthopaedic surgery. QUESTIONS/PURPOSES:For patients undergoing hip and knee arthroplasties, we asked (1) whether the score provides accurate risk stratification for major postoperative complications, and (2) whether it captures intraoperative variables contributing to postoperative risk based on the three parameters independent of preoperative risk. PATIENTS AND METHODS:We retrospectively reviewed the electronic records for all 3511 patients who underwent a hip or knee arthroplasty from March 2003 to August 2006 and extracted data to calculate a Surgical Apgar Score. We evaluated the relationship between scores and likelihood of major postoperative in-hospital complications and assessed its discrimination and calibration. RESULTS:Complication rates increased monotonically as the score decreased. Even after controlling for preoperative risk, each 1-point decrease in the score was associated with a 34.0% increase (95% confidence interval, 0.66-0.84) in the odds of a complication. The overall discriminatory performance of the score was a c-statistic of 0.61. Seventy-six percent of all major complications occurred in patients classified as low risk with scores of 7 or greater. CONCLUSIONS:For patients undergoing hip and knee arthroplasties, the score captures important intraoperative information regarding risk of complications and contributes additional information to preoperative risk, but on its own is insufficient to provide comprehensive postoperative risk stratification for arthroplasties. LEVEL OF EVIDENCE:Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Wuerz TH,Regenbogen SE,Ehrenfeld JM,Malchau H,Rubash HE,Gawande AA,Kent DMdoi
10.1007/s11999-010-1721-xsubject
Has Abstractpub_date
2011-04-01 00:00:00pages
1119-26issue
4eissn
0009-921Xissn
1528-1132journal_volume
469pub_type
杂志文章abstract：:Between 1977 and 1982, 19 cases of congenital dislocation of the hip (CDH) were encountered in black infants. Six of these cases were associated with other anomalies (atypical CDH); 13 were typical CDH. The incidence of complete CDH in the white population studied is 1.5/1000; in the black population studied it is 0.4...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1985-01-01 00:00:00
abstract：BACKGROUND:Although current guidelines do not recommend the routine use of surgical antibiotic prophylaxis to reduce the risk of surgical site infection following clean, soft tissue hand surgery, antibiotics are nevertheless often used in patients with an existing joint prosthesis to prevent periprosthetic joint infect...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/CORR.0000000000000801
更新日期：2019-10-01 00:00:00
abstract：:The tuck position used in conjunction with the tuck seat continues to satisfy the important requirements of lumbar spine surgery: satisfactory respiratory exchange, diminished venous oozing, and ample exposure. In 253 operations performed since 1971, minimal postoperative morbidity, including deep vein thrombosis, was...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1984-04-01 00:00:00
abstract：:The shoulder is characterized foremost by its mobility and large range of motion. The glenohumeral joint is notable for its relative lack of bony constraint, relying heavily on the congruent articulating surfaces and surrounding soft tissue envelope for static and dynamic stability. Effective function in the articulat...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：1996-09-01 00:00:00
abstract：:Sixteen porous polysulfone-coated canine femoral stems were inserted into 14 dogs. Coatings were approximately 40% porous, with an average pore size of 125 or 250 microns. Bone was formed within at least about 30% of the surface pores of the implants. The tissue ingrowths filling the pores included marrow and fibrous ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1983-06-01 00:00:00
abstract：:In 20 dogs olecranon osteotomies fixed with tension band wires were studied histologically to reveal the pattern of healing. Different degrees of stability existed in different areas of the osteotomy. Under stable conditions cancellous bone healed by direct formation of woven bone. Instability resulted in an internal ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1989-08-01 00:00:00
abstract：:This study attempted to evaluate whether total hip arthroplasty for displaced femoral neck fractures had significantly different outcomes when compared with total hip arthroplasty for osteoarthritis. This is a retrospective study of 60 patients who had total hip arthroplasties between 1997 and 2001. Thirty patients (m...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000127114.67635.19
更新日期：2004-04-01 00:00:00
abstract：:The repair of full thickness rotator cuff tears traditionally has included acromioplasty and coracoacromial ligament section. Acromioplasty can be complicated by deltoid detachment, compromise of the deltoid lever arm, anterosuperior instability, and adhesions of the rotator cuff tendons under the bleeding cancellous ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/00003086-200109000-00017
更新日期：2001-09-01 00:00:00
abstract：:A cross sectional study was performed to try to identify various demographic and radiologic risk factors for disease progression in 50 patients (79 hips) with corticosteroid associated osteonecrosis of the femoral head who had a core decompression. Thirty-one of the hips were in 18 patients who had systemic lupus eryt...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1997-01-01 00:00:00
abstract：:Few studies quantitate the cost of a quality well being as produced by arthroplasty surgery. The objective was to use the Quality of Well Being Index to calculate the cost per quality of well year in knee arthroplasty surgery. The difference in Quality of Well Being Index scores before and after the intervention was c...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1997-12-01 00:00:00
abstract：:The design of the Boston thoracolumbosacral orthosis for scoliosis treatment may increase intragastric pressure, possibly causing reflux esophagitis. Early recognition and aggressive medical treatment of reflux may avoid esophagitis and the need to either abandon or modify conservative scoliosis management. ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1981-09-01 00:00:00
abstract：:In 37 of 43 cases (86%) the late results of fasciotomy for chronic lateral epicondylitis were excellent or good. The initial result was maintained for an average of 8.0 years. The procedure is simple and morbidity is minimal. Patient selection and technical factors appeared to account for the failures. ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1978-09-01 00:00:00
abstract：:External malrotation is a frequent complication following Ender nailing. Biomechanical studies demonstrate that the standard Ender nail tends to produce external malrotation when the fracture is unstable. This type of malrotation does not develop to the same degree if the nails are bent into a 25 degree angle of antev...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1980-03-01 00:00:00
abstract：:Despite both longstanding and recent interest in patient-centered care, there are few published models or methods for defining and implementing patient-centered care in the office and hospital setting through a full cycle of care from the patient's perspective. We describe patient- and family-centered collaborative ca...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：2007-10-01 00:00:00
abstract：:Sixty patients with congenital upper-limb deficiency were evaluated for scoliosis in 1972. Twenty-one patients had scoliosis of 5 degrees or more and 15 had scoliosis of 10 degrees or more. Fifteen of these patients had long-term follow-up periods. Thirteen patients had idiopathic scoliosis. Idiopathic scoliosis assoc...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1986-01-01 00:00:00
abstract：:Bone morphogenic proteins (BMPs) may have neurotrophic functions but there is limited evidence of these functions in the peripheral nervous system. We therefore investigated the expression of BMPs and BMP receptors (BMPRs) in normal and injured peripheral nerves. In 10 of 15 Sprague-Dawley rats, a 3-mm segment of scia...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-009-1009-1
更新日期：2009-12-01 00:00:00
abstract：:The first 100 cases of the 135 THARIES surface replacement procedures with 4--32 months follow-up, are evaluated in terms of clinical results, radiographic information and complications. The short but detailed follow-up suggests that this procedure was an excellent alternative for the younger and more active populatio...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1978-07-01 00:00:00
abstract：:Osteolysis is defined as the process of progressive destruction of periprosthetic bony tissue, characterized on serial radiographs as progressive radiolucent lines and/or cavitation at the implant-bone or cement-bone interface. Without proper treatment, osteolysis may progress to aseptic loosening and catastrophic fai...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：2004-10-01 00:00:00
abstract：BACKGROUND:The benefits of robotic techniques for implanting femoral components during THA are still controversial. QUESTIONS/PURPOSES:The purpose of this study was to prospectively compare the results and complications of robotic-assisted and hand-rasping stem implantation techniques. METHOD:The minimum followup was...
journal_title：Clinical orthopaedics and related research
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1007/s11999-009-1158-2
更新日期：2010-04-01 00:00:00
abstract：:Four hundred twenty-one posterior cruciate condylar total knee arthroplasties were performed between 1975 and 1983. Anatomic alignment of the knee was recorded on follow-up evaluations from two months to 13 years postoperatively. Patients were stratified into a normal group that was 5 degrees to 8 degrees anatomic val...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1994-02-01 00:00:00
abstract：:The purpose of this study was to quantify precisely aging-induced changes in skeletal perfusion and bone mechanical properties in a small rodent model. Blood flow was measured in conscious juvenile (2 months old), adult (6 months old), and aged (24 months old) male Fischer-344 rats using radiolabeled microspheres. The...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200203000-00036
更新日期：2002-03-01 00:00:00
abstract：:The treatment of hip disorders in adolescents and young adults has evolved rapidly during the past decade because of enhanced understanding of prearthritic and early arthritic hip disease combined with improved diagnostic skills, better patient selection criteria, and refinements in alternative surgical procedures. De...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/01.blo.0000193511.91643.2a
更新日期：2005-12-01 00:00:00
abstract：UNLABELLED:The need for segmental resection versus intralesional treatment of low-grade chondrosarcomas of the appendicular skeleton remains controversial. We hypothesized extended intralesional treatment would equally control malignant disease but with improved functional outcomes and decreased postoperative complicat...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-008-0691-8
更新日期：2009-08-01 00:00:00
abstract：:The osteopenia associated with advanced age appears to be a universal phenomenon in humans and animals, but the mechanisms by which it occurs are understood incompletely. However, the explanation must lie in an absolute or relative diminution in the level of osteoblastic bone-forming activity when compared with osteoc...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1995-04-01 00:00:00
abstract：:Nineteen patients had a severe neurologic deficit and persistent dysesthetic pain after total hip replacement. During surgery their limbs had been lengthened by 1.3 to 4.1 cm. Patients with other reasons for nerve injury such as hematoma, dislocation, or direct operative trauma were excluded. Also excluded were patien...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200401000-00027
更新日期：2004-01-01 00:00:00
abstract：:The precise nature of the motion of the knee during a pivot shift is of interest when types of knee instability are correlated with specific injuries. Ten subjects with anterior cruciate ligament injuries and demonstrable pivot shift instabilities were examined with a triaxial electrogoniometer to detect angular motio...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1984-03-01 00:00:00
abstract：:Posterior glenoid osteotomy (posterior glenoplasty) is a standard surgical reconstructive operation for recurrent posterior instability of the shoulder. A 34-year-old man was treated by glenoid osteotomy and subsequently developed significant glenohumeral arthritis. Following several surgical procedures, only total sh...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1984-07-01 00:00:00
abstract：:A long-term clinical study of 41 Flatt metallic hinged prostheses inserted in the metacarpophalangeal joints of ten rheumatoid patients was completed to provide a historic and clinical perspective of the ongoing clinical performance of this prosthesis. Postsurgical analysis performed an average of 138 months after ope...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1984-04-01 00:00:00
abstract：UNLABELLED:Results of total knee arthroplasty have demonstrated excellent pain relief and increased patient function, particularly in activities such as walking. This procedure has not always met the needs of certain ethnic and religious groups as well as younger patients who require greater magnitudes of knee flexion....
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/BLO.0b013e31812f785d
更新日期：2007-11-01 00:00:00
abstract：:Thirty-eight total knee arthroplasties in 36 patients were studied at 4 +/- 2 (mean, +/- SD) years follow-up evaluation. The Hospital for Special Surgery knee score improved from 59 +/- 9 (mean, +/- SD) before surgery to 83 +/- 11 (mean, +/- SD) (p less than 0.0001) at last evaluation. Good or excellent results were a...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1991-12-01 00:00:00
