Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures

© 2020 Delhi Orthopedic Association Background: Open pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality. Methods: A query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher\u27s exact test and chi-square test for categorical variables, and Welch\u27s t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications. Results: A total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality. Conclusion: We report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population. Level of Evidence: Level II, Retrospective study

Risk factors for hospital admission in patients undergoing outpatient anterior cruciate ligament reconstruction: A national database study

© 2020 Professor P K Surendran Memorial Education Foundation Introduction: Anterior Cruciate Ligament Reconstructions (ACLR) are routinely performed in an outpatient setting with low 90-day readmission rates (2.3%); however, admissions rates in the immediate perioperative period have been previously reported as high as 13.1%. Despite the surprisingly high number of patients requiring immediate perioperative admission, there has been a lack of recent literature specifically examining the associated risk factors for admission. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, a query for patients who underwent ACLR from 2011 through 2018 was performed using Current Procedural Terminology codes. The following concomitant procedures were included: meniscectomy, meniscal repair, diagnostic arthroscopy, loose body removal, synovectomy, chondroplasty, abrasion chondroplasty, drilling for osteochondritis dissecans. Demographics including age, sex, race, body mass index (BMI) and comorbidities were collected. Perioperative factors collected were anesthesia type and operative times. Patient demographic and perioperative data were compared using Fisher\u27s exact test and Pearson\u27s chi-square test. Multivariate logistic regressions were used to calculate odds ratios (OR) and 95% confidence intervals (CI) of independent risk factors for postoperative admission. Holm-Bonferroni method yielded adjusted p-value thresholds for significance. Results: Of the 20,819 patients undergoing ACLR with and without concomitant procedures, 3.8% of patients were admitted to the hospital in the immediate postoperative period. Following multivariate regression analysis, increased odds of admission were demonstrated with the use of regional anesthesia alone (OR = 2.77, 95%CI: 2.22–3.44; p \u3c 0.001), increasing concurrent procedures (Table 1), and obesity classes II (OR = 1.62, 95%CI: 1.26–2.10; p \u3c 0.001) and III (OR = 1.81, 95%CI: 1.33–2.47; p \u3c 0.001). Subsequent subgroup analysis of the isolated ACLR procedures (N = 9,423) demonstrated a 3.3% postoperative admission rate. Multivariate regressions demonstrated increased odds of admission with regional anesthesia use only (OR = 2.62, 95%CI: 1.90–3.60; p \u3c 0.001), obesity class II (OR = 2.22, 95%CI: 1.51–3.26; p \u3c 0.001), and increasing minutes of operative time (OR = 1.01, 95%CI: 1.01–1.01; p \u3c 0.001). Table 2 demonstrates increasing rates and odds of admission with increasing operative time in hours. Conclusion: Anterior Cruciate Ligament Reconstructions are routinely performed in an outpatient setting; nevertheless, a subset of ACLR patients is admitted postoperatively. We found an increased risk of admission with the use of regional anesthesia alone, increasing concurrent procedures and obesity classes II and III. A further understanding of patient risk factors for those undergoing ACLR allows orthopedic surgeons to better develop a preoperative plan and discuss patient expectations, which will lead to more efficient resource allocation and improved patient satisfaction