Comparison of risk factors for postoperative complications across age groups in patients undergoing ORIF of the ankle

McKissack, Haley; Viner, Gean C.; Jha, Aaradhana J.; Wilson, John T.; Anderson, Matthew; McGwin, Gerald; Shah, Ashish

doi:10.1016/j.injury.2019.09.014

Cited by 7 publications

(11 citation statements)

References 31 publications

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“…For example, in a study looking at 886 patients undergoing ORIFs for closed, non-polytraumatic, non-pilon ankle fractures, risk for postoperative infection among older patients above 50 years with hypertension (RR ¼ 3.52, p ¼ 0.004) was greater than the risk for younger patients (RR ¼ 2.46, p ¼ 0.017). 10 As seen with these prior studies, although the impact of hypertension on postoperative complications of older patients undergoing surgery is well documented, there is a limited literature about whether this risk increases for octogenarians relative to their younger geriatric counterparts. However, there are several orthopaedic studies that are in contrary to this study's findings of an increased risk for postoperative complications in hypertensive octogenarians.…”

Section: Discussionmentioning

confidence: 97%

Extended length of stay and postoperative complications in octogenarians with hypertension following revision total knee arthroplasty

Gupta

Quan

Patel

et al. 2022

Journal of Clinical Orthopaedics and Trauma

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Background: Prior studies have shown hypertensive patients to be at an increased risk of postoperative complications following various surgeries, including revision total knee arthroplasty (rTKA). However, whether these risks are compounded in octogenarian patients has not yet been well explored. The purpose of this study was to analyze whether hypertensive octogenarians, aged 80 to 89, undergoing rTKA are at an increased risk of postoperative complications relative to the younger hypertensive geriatric population aged 65 to 79. Methods: A national database was used to collect data for all hypertensive patients who underwent rTKA from 2006 to 2018. Patients were stratified into an aged 65 to 79 cohort and an aged 80 to 89 cohort. Demographics, medical comorbidities, and postoperative complications were compared between the two cohorts. Bivariate and multivariate analyses were performed. Results: Of the 6,599 hypertensive patients who underwent rTKA, 5,477 (83.0%) patients were in the aged 65 to 79 group and 1,122 (17.0%) patients were in the aged 80 to 89 group. Following adjustment to control for demographic and comorbidity data, relative to patients in the 65 to 79 age group, hypertensive patients who were 80e89 years old had an increased risk of unplanned reintubation (OR 3.52; p ¼ 0.008), urinary tract infection (OR 2.08; p ¼ 0.011), postoperative transfusion (OR 1.90; p < 0.001), myocardial infarction (OR 2.55; p ¼ 0.017), and extended length of hospital stay (OR 1.77; p < 0.001). Conclusion: Hypertensive octogenarian patients undergoing rTKA have an increased risk of an extended length of stay and other postoperative complications relative to their younger hypertensive geriatric counterparts. Orthopaedic surgeons should consider a multi-disciplinary approach to managing hypertension in these octogenarian patients prior to surgery to minimize this risk. However, even with this risk, an octogenarian age should not be used independently in evaluating if a hypertensive geriatric patient is a safe rTKA candidate.

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Section: Discussionmentioning

confidence: 97%

Extended length of stay and postoperative complications in octogenarians with hypertension following revision total knee arthroplasty

Gupta

Quan

Patel

et al. 2022

Journal of Clinical Orthopaedics and Trauma

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“… 44 Prior studies evaluating complications after ankle fracture surgery have not examined the effect of ethnicity on adverse outcomes. 4 , 7 , 9 , 28 , 30 , 32 , 34 , 41 …”

Section: Discussionmentioning

confidence: 99%

“…None of the prior studies have assessed the impact of anesthesia type on complications after ORIF of ankle fractures. 4 , 7 , 9 , 28 , 38 , 41 This finding can be due to selection bias, where the sicker patients with more comorbidities were given neuraxial anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Although the prevalence of smoking was 14% in the United States in 2019 11 and around 20% globally, 36 there are still conflicting reports regarding the effect of smoking on outcomes after ankle fracture surgery. Although several studies have found smoking to be a risk factor for complications in ORIF of ankle fractures, 5 , 21 , 28 , 29 , 32 , 37 , 39 , 40 , 50 some have failed to show an increased risk in smokers. 4 , 30 , 33 , 35 , 43 …”

Section: Introductionmentioning

confidence: 99%

“…To improve outcomes, several studies have previously addressed the complications after ankle fracture surgery and tried to identify risk factors for those adverse events. 4 , 7 , 9 , 25 , 27 , 28 , 30 , 34 , 41 Diabetes 14 , 16 , 23 , 25 - 27 , 49 and obesity 8 , 24 , 42 have been identified as risk factors for several complications in ORIF of ankle fractures. Although the prevalence of smoking was 14% in the United States in 2019 11 and around 20% globally, 36 there are still conflicting reports regarding the effect of smoking on outcomes after ankle fracture surgery.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparing the 30-Day Complications Between Smokers and Nonsmokers Undergoing Surgical Fixation of Ankle Fractures

Sagherian

Hoballah

Tamim

2022

Foot & Ankle Orthopaedics

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Background: There have been conflicting reports regarding the effect of smoking on complications after surgical treatment of ankle fractures. This study aimed at identifying the complications for which smokers and subgroups of smokers are at a higher risk compared to nonsmokers when undergoing surgery for fixation of rotational ankle fractures. Methods: The American College of Surgeons National Surgical Quality Improvement Program data set from 2008 to 2019 was used to compare the 30-day wound, cardiac, renal, and infectious complications, related readmissions, and return to the operating room between the 2 cohorts. Results: Of 33 741 patients included, 25 642 (76.0%) were nonsmokers and 8099 (24.0%) were smokers. Multivariate analysis showed that smokers were at a higher risk for deep wound infection (OR 2.34, 95% CI 1.48-3.69, P < .001), wound dehiscence (OR 2.43, 95% CI 1.56-3.77, P < .001), related return to the operating room (OR 1.69, 95% CI 1.36-2.11, P < .001), and related readmissions (OR 1.67, 95% CI 1.32-2.09, P < .001). Smokers at an increased risk for deep infection included patients between 50 and 59 years (OR 5.75, 95% CI 1.78-18.5, P = .003), who were Black (OR 4.24, 95% CI 1.04-17.23, P = .044), who had body mass index (BMI) 35 to 39.9 (OR 3.73, 95% CI 1.46-9.50, P = .006), or operative times between 60 and 90 minutes (OR 3.64, 95% CI 1.79-7.39, P < .001). Smoker subgroups at a higher risk for wound dehiscence included patients between 50 and 59 years (OR 9.86, 95% CI 3.29-29.53, P < .001), with operative times between 90 and 120 minutes (OR 4.88, 95% CI 1.89-12.58, P < .001), with BMI 30 to 34.9 (OR 3.06, 95% CI 1.45-6.45, P = .003) and who underwent spinal/epidural anesthesia (OR 9.31, 95% CI 2.31-37.58, P = .002). Conclusion: Smokers were at an increased risk for deep wound infection, wound dehiscence, related reoperations, and related readmissions after ankle fracture surgery. Certain subgroups were at an even higher risk for these complications. Level of Evidence: Level III, retrospective cohort study.

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The effectiveness of cold oral stimuli in quenching postoperative thirst: A systematic review and meta-analysis

Tsai

Chao

Hsiao

2023

Intensive and Critical Care Nursing

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Comparison of risk factors for postoperative complications across age groups in patients undergoing ORIF of the ankle

Cited by 7 publications

References 31 publications

Extended length of stay and postoperative complications in octogenarians with hypertension following revision total knee arthroplasty

Extended length of stay and postoperative complications in octogenarians with hypertension following revision total knee arthroplasty

Comparing the 30-Day Complications Between Smokers and Nonsmokers Undergoing Surgical Fixation of Ankle Fractures

The effectiveness of cold oral stimuli in quenching postoperative thirst: A systematic review and meta-analysis

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