The epidemiology of reoperations for orthopaedic trauma

Abstract

INTRODUCTION The Royal College of Surgeons of England (RCS) has issued guidance regarding the use of reoperation rates in the revalidation of UK-based orthopaedic surgeons. Currently, little has been published concerning acceptable rates of reoperation following primary surgical management of orthopaedic trauma, particularly with reference to revalidation. METHODS A retrospective review was conducted of patients undergoing clearly defined reoperations following primary surgical management of trauma between 1 January 2010 and 31 December 2011. A full case note review was undertaken to establish the demographics, clinical course and context of reoperation. A review of the imaging was performed to establish whether the procedure performed was in line with accepted trauma practice and whether the technical execution was acceptable. RESULTS A total of 3,688 patients underwent primary procedures within the time period studied while 70 (1.90%, 99% CI: 1.39-2.55) required an unplanned reoperation. Thirty-nine (56%) of these patients were male. The mean age of patients was 56 years (range: 18-98 years) and there was a median time to reoperation of 50 days (IQR: 13-154 days). Potentially avoidable reoperations occurred in 41 patients (58.6%, 99% CI: 43.2-72.6). This was largely due to technical errors (40 patients, 57.1%, 99% CI: 41.8-71.3), representing 1.11% (99% CI: 0.73-1.64) of the total trauma workload. Within RCS guidelines, 28-day reoperation rates for hip, wrist and ankle fractures were 1.4% (99% CI: 0.5-3.3), 3.5% (99% CI: 0.8%-12.1) and 1.86% (99% CI: 0.4-6.6) respectively. CONCLUSIONS We present novel work that has established baseline reoperation rates for index procedures required for revalidation of orthopaedic surgeons.

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

“…Previous studies have been limited by composite outcome analyses in which mechanical/technical failures were grouped with other complications such as wound dehiscence, infection, medical complications, or hardware removal. 1,14,41,48,54,56 We excluded cases revised alongside wound complications while expanding the study window to 12 months in hopes of analyzing not only early reoperations based on technical failures but also those performed for mechanical failures of fixation or delayed/nonunion. Additionally, we compared our adequately powered revision cohort to a matched control group and analyzed data using both univariate and multivariable analyses to minimize confounders and maximize the clinical applicability of our findings.…”

“…While early reoperation rates (within 12 months of index ORIF) are low, from 0.82% to 3.7% in most series, reports as high as 7.8% have been published. 1,5,26,31,42,48,56,60 Multiple previous studies have investigated the incidence of and risk factors associated with wound complications after operative treatment. 14,33,37,48,62 Similarly, work by Ovaska et al 42 identified technical errors leading to the need for acute revision.…”

“…Reoperation due to technical or mechanical complications is typically reported alongside soft tissue–related complications such as wound dehiscence or infection, which are statistically more common. 1,30,31,37,48,54,55,60…”

Stable rates of operative treatment of distal radius fractures in Ontario, Canada: a population-based retrospective cohort study (2004–2013)

“…This was a conservative decision based on reoperation data. 16 This also meant that in patients with bilateral fractures, only the first documented fracture was counted.…”

Single versus separate implant fixation for concomitant ipsilateral femoral neck and shaft fractures: A systematic review

“…Up to 1.9% of patients undergoing an orthopedic trauma procedure have been shown to require an unplanned reoperation, 43 and in the context of the significant costs associated with a hospital bed day, 44 reduced rate of reoperation can be associated with an improvement in economic burden in addition to the obvious patient benefits. In previous studies, the rate of reoperation was lower in the separate device cohort, 25 which is consistent with the findings of this review, in which 11.1% of the nail cohort proceeded on to having at least one further orthopedic intervention, versus 6.25% of the separate device cohort.…”