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：:Surgical fusion may be indicated to stabilize deformed or painful hindfoot joints. Although more commonly performed in children or adolescents, it is the salvage procedure available for adults. Twenty-six patients (30 feet; 20 women, six men) followed for an average of 44.1 months after hindfoot arthrodesis were inves...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1990-08-01 00:00:00
abstract：:Considering the often poor results obtained with conventional methods of bone grafting in the treatment of congenital pseudarthrosis of the tibia, the free vascularized bone graft may offer the best chance of cure to these unfortunate patients. A segment of rib or fibula may be harvested with its vascular supply and u...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-06-01 00:00:00
abstract：:Regional cortical blood flow was measured in 23 adult mongrel dogs using the hydrogen washout technique. Cortical blood flow in the rib was found to be 4.7 +/- 0.8 ml/min/100 ml (n=21). The concept of a dual blood supply to cortical bone is supported since eliminating the medullary supply did not affect the measurable...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-05-01 00:00:00
abstract：:Dislocation after hip replacement occurs at an overall incidence of 2% to 3% and has significant cost and morbidity implications. Statistically increased incidence is observed in females and in the elderly, and after reoperation procedures. Specific causes include cup malrotation, trochanteric migration, and decreased...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1997-11-01 00:00:00
abstract：:Prompt diagnosis of proximal lower extremity deep vein thrombosis in outpatients is critical because of the risk of pulmonary embolism. Our purpose was to determine the accuracy of orthopaedists' clinical decisions regarding the diagnosis of proximal deep vein thrombosis in outpatients. A nationally representative ran...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000152599.53574.a5
更新日期：2005-03-01 00:00:00
abstract：:After a short term of employment in a new job, 3 young heroin addicts became disabled from low back pain due to neisseria gonorrhea prostatitis. Each returned to work after a few weeks of antibiotic therapy without symptoms following proper diagnosis. These patients demonstrate the importance of a careful history and ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1977-01-01 00:00:00
abstract：BACKGROUND:The majority of published functional outcome data for tumor megaprostheses comes in the form of subjective functional outcome scores. Sparse objective data exist demonstrating functional results, activity levels, and efficiency of gait after endoprosthetic reconstruction in patients treated for orthopaedic t...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-014-3655-1
更新日期：2015-03-01 00:00:00
abstract：:Osteoarticular defects present a reparative challenge to orthopaedic surgeons. Osteoarticular allografts provided a promising solution. Unfortunately, many of these allografts failed secondary to articular cartilage degeneration. To determine the role of the extracellular matrix in graft failure, the authors have char...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200101000-00004
更新日期：2001-01-01 00:00:00
abstract：:The efficiency of ultraviolet light and fluorescence macrophotography in screening various tissues of the locomotor system was tested on 46 human and 43 animal specimens from surgical, experimental and autopsy material, examined as living tissues during operation, or as fresh, frozen or fixed specimens. After visual e...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-197511000-00033
更新日期：1975-11-01 00:00:00
abstract：:A cement-free bioceramic aluminum oxide double cup endoprosthesis is under investigation as an alternative to the cemented stem endoprosthesis. Nine patients with 11 operated hips are without complaints after an average of 20.8 months (range 8--28 months). Early loosening of 2 femoral components occurred because of te...
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：BACKGROUND:An assortment of variables has been used in predicting anterior shoulder instability resulting from pathologic engagement of Hill-Sachs lesions on the glenoid. The glenoid track is a unique biomechanical model that relates both Hill-Sachs and bony Bankart lesions to predict shoulder engagement. We examined t...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1007/s11999-014-3589-7
更新日期：2014-08-01 00:00:00
abstract：:An aggregate of biodegradable beta-tricalcium phosphate and bone morphogenetic protein (BMP/TCP) induces the differentiation of cartilage within eight days, cartilage and woven bone within 12 days, and lamellar bone, including bone marrow, within 21 days. The yield of new bone from a 1-mg dose was more than 12 times g...
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：:Although compression plate fixation of diaphyseal long bone fractures is accepted treatment, surgical exposure and plate position in relation to the periosteum are controversial. Histologic, roentgenographic, and biomechanical methods were applied to investigate quality and chronology of healing in radial and ulnar fr...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1983-05-01 00:00:00
abstract：:The natural history of degenerative lumbar spinal stenosis is documented poorly. Little is known about the efficacy of nonoperative treatments. An aggressive nonoperative treatment consisting of therapeutic exercise, analgesics, and epidural steroid injections is proposed. The clinical evaluation of the patients is re...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200103000-00018
更新日期：2001-03-01 00:00:00
abstract：UNLABELLED:Although acute management of pelvic fractures and their long-term functional outcome have been widely documented, important information regarding malunion and nonunion of these fractures is sparse. Despite their relative rarity, malunions and nonunions cause disabling symptoms and have major socioeconomic im...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1007/s11999-009-0712-2
更新日期：2009-08-01 00:00:00
abstract：BACKGROUND:Reconstruction of the extensor mechanism after resection of the proximal tibia is challenging, and several methods are available. A medial gastrocnemius flap commonly is used, although it may be associated with an extensor lag. This problem also is encountered, although perhaps to a lesser extent, with other...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-013-2851-8
更新日期：2013-07-01 00:00:00
abstract：:Modification of the implant surface with the Arg-Gly-Asp tripeptide (RGD) putatively facilitates osteoblast attachment for improved implant fixation in the laboratory. We compared the histomorphometric and mechanical performance of titanium implants coated with RGD using a novel interface of self-assembled monolayers ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-008-0117-7
更新日期：2008-04-01 00:00:00
abstract：:Hip fractures are common injuries in the elderly and are associated with considerable morbidity and mortality. Although technical advances in the treatment of the elderly have resulted in improved fracture fixation and surgical outcomes, clinical pathways have been developed to further improve patient outcome while sh...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000132266.59787.d2
更新日期：2004-08-01 00:00:00
abstract：:To investigate the role of blood supply in the pathogenesis of idiopathic osteonecrosis of the femoral head, superselective angiography of the medial circumflex artery was performed. Sixteen hips with early stage osteonecrosis diagnosed by bone scintigraphy were studied, as were 22 contralateral normal hips (from unil...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1992-04-01 00:00:00
abstract：:Managing tumors of the proximal fibula may require en bloc resection of the fibular head with the attachment site for the lateral collateral ligament. These resections of the proximal fibula cause unavoidable knee instability. We describe a reconstructive technique intended to minimize that instability. We retrospecti...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000238781.19692.16
更新日期：2007-01-01 00:00:00
abstract：:Thirty-two consecutive subtrochanteric fractures in 32 patients were stabilized using the Medoff sliding plate and were followed up prospectively for 1 year. Two patients died during the first postoperative year. Twenty-nine of the remaining 30 (97%) fractures united by 1-year followup. Two types of plate dynamization...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1998-03-01 00:00:00
abstract：BACKGROUND:In a previous study, we described the distribution of coronal alignment in a normal asymptomatic population and recognized the occurrence of constitutional varus in one of four individuals. It is important to further investigate the influence of this condition on the joint line orientation and how the latter...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-013-2898-6
更新日期：2014-01-01 00:00:00
abstract：:An aggressive and recurrent pigmented villonodular synovitis of the knee occurred in a 47-year-old man. Magnetic resonance imaging was an excellent noninvasive diagnostic aid that completely outlined the extent of the synovitis and correlated well with surgical findings. ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1988-11-01 00:00:00
abstract：:The purpose of this study was to determine trends and differences between various medical specialties with regard to the treatment of postmenopausal osteoporosis. The method used was a cross-sectional survey, and the authors' sample was composed of 116 physicians. There was an overall lack of consensus on choice of tr...
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：:The absolute treatment of extensively involved cases of Legg-Calvé-Perthes disease (LCPD) remains unsolved. The basic principle of adequate containment of the capital femoral epiphysis in its acetabulum while minimizing the disability time is widely accepted, but the definition of adequate containment and methods of a...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1980-07-01 00:00:00
abstract：:The results of revision total hip arthroplasty, with or without sepsis, are compared in a review of the recent literature. In 661 total hip revisions without sepsis, there is an overall 54% excellent/good/satisfactory rate and a 12% infection rate. Of 1063 total hip revisions in the presence of or after sepsis, there ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-10-01 00:00:00
abstract：:Twenty-eight joints with heterotopic ossification in 16 head-injured adults were forcefully manipulated 39 times under general anesthesia. The etiology of the heterotopic bone was trauma in seven joints and idiopathic (neurogenic) in 21. Indications for manipulation were inability to participate in therapy due to a lo...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-09-01 00:00:00
abstract：:In this literature review, 30 reports provided outcome data on 37 direct exchange arthroplasties, 530 open debridements, and 23 arthroscopic debridements. The average followup was approximately 4 years, but the range was broad (range, 0.02-14 years). Infection was controlled in 33 of the 37 infected total knee arthrop...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200211000-00022
更新日期：2002-11-01 00:00:00
abstract：:A rare case of anterior slip of the capital femoral epiphysis demonstrates that the mechanism of the posterior, inferior slip of the capital femoral epiphysis is a combination of weight bearing in the frontal plane and muscle pull in the horizontal plane. Sudden violent motions cause some of the unusual positions of a...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-197507000-00022
更新日期：1975-07-01 00:00:00
abstract：BACKGROUND:Historically, physicians as participants in healthcare governance were shunned because of perceived potential for conflict of interest. This maxim is being revisited as health systems begin to appreciate the value presented by physician leaders. QUESTIONS/PURPOSES:This overview of the orthopaedist's role in...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-013-2950-6
更新日期：2013-06-01 00:00:00
