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Rheumatology (Oxford). 2014 Jul;53(7):1186-93. doi: 10.1093/rheumatology/ket431. Epub 2013 Dec 24.

Perioperative factors affecting the occurrence of acute complex regional pain syndrome following limb bone fracture surgery: data from the Japanese Diagnosis Procedure Combination database.

Author information

1
Department of Anesthesiology and Pain Relief Center, Department of Medical Engineering, The University of Tokyo Hospital, Department of Health Economics and Epidemiology Research, School of Public Health, University of Tokyo, Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Department of Orthopaedic Surgery, School of Medicine, Keio University, Department of Medical Informatics and Economics, Graduate School of Medicine, University of Tokyo, Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo and Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan.Department of Anesthesiology and Pain Relief Center, Department of Medical Engineering, The University of Tokyo Hospital, Department of Health Economics and Epidemiology Research, School of Public Health, University of Tokyo, Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Department of Orthopaedic Surgery, School of Medicine, Keio University, Department of Medical Informatics and Economics, Graduate School of Medicine, University of Tokyo, Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo and Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan. sumitanim-ane@h.u-tokyo.ac.jp.
2
Department of Anesthesiology and Pain Relief Center, Department of Medical Engineering, The University of Tokyo Hospital, Department of Health Economics and Epidemiology Research, School of Public Health, University of Tokyo, Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Department of Orthopaedic Surgery, School of Medicine, Keio University, Department of Medical Informatics and Economics, Graduate School of Medicine, University of Tokyo, Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo and Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan.

Abstract

OBJECTIVE:

Complex regional pain syndrome (CRPS) describes a broad spectrum of symptoms that predominantly localize to the extremities. Although limb fracture is one of the most frequently reported triggering events, few large-scale studies have shown the occurrence of and factors associated with CRPS following limb fracture. This study aimed to show the occurrence and identify of those factors.

METHODS:

Using the Japanese Diagnosis Procedure Combination database, we identified 39 patients diagnosed with CRPS immediately after open reduction and internal fixation (ORIF) for limb fracture from a cohort of 185 378 inpatients treated with ORIF between 1 July and 31 December of each year between 2007 and 2010. Patient and clinical characteristics such as age, gender, fracture site, duration of anaesthesia and use of regional anaesthesia were investigated by logistic regression analyses to examine associations between these factors and the in-hospital occurrence of CRPS after ORIF.

RESULTS:

The occurrence of CRPS was relatively high in fractures of the distal forearm, but low in fractures of the lower limb and in patients with multiple fractures. Generally females are considered to be at high risk of CRPS; however, we found a comparable number of male and female patients suffering from CRPS after ORIF for limb fracture. In terms of perioperative factors, a longer duration of anaesthesia, but not regional anaesthesia, was significantly associated with a higher incidence of CRPS.

CONCLUSION:

Although a limited number of CRPS patients were analysed in this study, reduced operative time might help to prevent the development of acute CRPS following limb fracture.

KEYWORDS:

bone fracture; complex regional pain syndrome; factors; open reduction and internal fixation; regional anaesthesia

Comment in

PMID:
24369418
DOI:
10.1093/rheumatology/ket431
[Indexed for MEDLINE]
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