Risk Factors for 30-Day Postoperative Complications and Mortality Following Open Reduction Internal Fixation of Distal Radius Fractures

Schick, Cameron W.; Koehler, Daniel M.; Martin, Christopher T.; Gao, Yubo; Pugely, Andrew J.; Shah, Apurva S.; Adams, Brian D.

doi:10.1016/j.jhsa.2014.09.017

Cited by 42 publications

(54 citation statements)

References 30 publications

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“…In their recent publication, Schick et al identified risk factors for complications following operative fixation of distal radius fractures. 10 A higher total complication rate following inpatient distal radius fracture ORIF compared with outpatient surgery (10 vs. 1.3%) was reported as a secondary outcome. Interestingly, the authors performed a post hoc univariate analysis between the inpatient and outpatient groups and found significant differences in mean age, incidence of COPD and bleeding disorders, ASA physical status classification, and length of surgery.…”

Section: Discussionmentioning

confidence: 93%

“…Risk factors for complications following open reduction and internal fixation (ORIF) of distal radius fractures were reported in a recent publication by Schick et al using the 2011 American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database. 10 Overall complication rates were generally low, but the authors reported a significantly higher rate of complications among patients who underwent distal radius ORIF in the inpatient setting compared with the outpatient setting. However, as the authors acknowledged, there were significant differences in patient demographics and medical comorbidities between inpatient and outpatient groups, and these differences were not evaluated with further statistical analysis.…”

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confidence: 94%

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Patients at Increased Risk of Major Adverse Events Following Operative Treatment of Distal Radius Fractures: Inpatient versus Outpatient

et al. 2017

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The purpose of this study was to compare complication rates following inpatient versus outpatient distal radius fracture ORIF and identify specific complications that occur at increased rates among inpatients. Using the 2005-2013 ACS-NSQIP, we collected patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complications following isolated ORIF of distal radius fractures. A propensity score matched design using an 8-to-1 "greedy" matching algorithm in a 1:4 ratio of inpatients to outpatients was utilized. Rates of minor, major, and total complications were compared. A multinomial logistic regression model was then used to assess the odds of complications following inpatient surgery. Total 4,016 patients were identified, 776 (19.3%) of whom underwent inpatient surgery and 3,240 (80.3%) underwent outpatient surgery. The propensity score matching algorithm yielded a cohort of 629 inpatients who were matched with 2,516 outpatients (1:4 ratio). After propensity score matching, inpatient treatment was associated with increased rates of major and total complications but not with minor complications. There was an increased odds of major complications and total complications following inpatient surgery compared with outpatient surgery. There was no difference in odds of minor complications between groups. Inpatient operative treatment of distal radius fractures is associated with significantly increased rates of major and total complications compared with operative treatment as an outpatient. Odds of a major complication are six times higher and odds of total complications are two and a half times higher following inpatient distal radius ORIF compared with outpatient. Quality improvement measures should be specifically targeted to patients undergoing distal radius fracture ORIF in the inpatient setting.

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Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 94%

Patients at Increased Risk of Major Adverse Events Following Operative Treatment of Distal Radius Fractures: Inpatient versus Outpatient

et al. 2017

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“…Two groups recently published NSQIP analyses of complications after open reduction internal fixation of distal radius fractures. 12,13 Jiang et al 12 included 3,003 patients from 2006 to 2012 and reported a complication incidence of 2%. The most common complications were return to the operating room (1.2%), infection (0.3%), blood transfusion (0.2%), UTI (0.2%), and death (0.2%), which were similar to our results.…”

Section: Discussionmentioning

confidence: 99%

“…ASA class III or IV, dependent functional status, hypertension, and myocardial infarction/CHF were independent risk factors for complications. 13 Analyzing the subset of our study population that underwent distal radius fracture open reduction internal fixation (1,887 patients), 22 (1%) experienced a complication. This lower incidence of complications is in part because we did not include reoperation as a complication, because the indication for the second operation is not recorded in NSQIP.…”

Section: Discussionmentioning

confidence: 99%

Complications Within 30 Days of Hand Surgery: An Analysis of 10,646 Patients

Lipira

Sood

Tatman

et al. 2015

The Journal of Hand Surgery

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“…The incidence and corresponding risk factors for complications following several hand surgeries have been well described in the literature. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Lipira et al, in a retrospective study analyzing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, found an overall complication rate within 30 days of hand surgery to be 2.5% with associated risk factors including male sex, increasing American Society of Anesthesiologists class, increasing wound class, preoperative transfusion, and inpatient surgery. 6 Whiting et al specifically compared complication rates in outpatient and inpatient distal radius open reduction internal fixation (ORIF) using the NSQIP database, showing significantly fewer total and major complications in the outpatient group.…”

Section: Introductionmentioning

confidence: 99%

Timing of Complications following Hand Surgery

Goyal

Bohl

Wysocki

2022

Journal of Hand and Microsurgery

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Introduction Our purposes were to (1) characterize the timeline of eight postoperative complications following hand surgery, (2) assess complication timing for the procedures that account for the majority of adverse events, and (3) determine any differences in complication timing between outpatient and inpatient procedures. Materials and Methods Patients undergoing hand, wrist, and forearm procedures from 2005 to 2016 were identified in the National Surgical Quality Improvement Program database. Timing of eight adverse events was characterized. Cox proportional hazards modeling was used to compare adverse event timing between inpatient and outpatient procedures. Results A total of 59,040 patients were included. The median postoperative day of diagnosis for each adverse event was as follows: myocardial infarction 1, pulmonary embolism 2, acute kidney injury 3, pneumonia 8, deep vein thrombosis 9, sepsis 13, urinary tract infection 15, and surgical site infection 16. Amputations, fasciotomies, and distal radius open reduction internal fixation accounted for the majority of adverse events. Complication timing was significantly earlier in inpatients compared with outpatients for myocardial infarction. Conclusion This study characterizes postoperative adverse event timing following hand surgery. Surgeons should have the lowest threshold for testing for each complication during the time period of greatest risk. Level of Evidence This is a therapeutic, Level III study.

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Risk Factors for 30-Day Postoperative Complications and Mortality Following Open Reduction Internal Fixation of Distal Radius Fractures

Cited by 42 publications

References 30 publications

Patients at Increased Risk of Major Adverse Events Following Operative Treatment of Distal Radius Fractures: Inpatient versus Outpatient

Patients at Increased Risk of Major Adverse Events Following Operative Treatment of Distal Radius Fractures: Inpatient versus Outpatient

Complications Within 30 Days of Hand Surgery: An Analysis of 10,646 Patients

Timing of Complications following Hand Surgery

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