Length of stay and 30-day readmissions after isolated humeral shaft fracture open reduction and internal fixation compared to intramedullary nailing

Robert K Merrill; Sara L Low; Varun Arvind; Colin M Whitaker; Emmanuel M Illical

doi:10.1016/j.injury.2020.02.001

Length of stay and 30-day readmissions after isolated humeral shaft fracture open reduction and internal fixation compared to intramedullary nailing

Injury. 2020 Apr;51(4):942-946. doi: 10.1016/j.injury.2020.02.001. Epub 2020 Feb 3.

Authors

Robert K Merrill¹, Sara L Low², Varun Arvind³, Colin M Whitaker², Emmanuel M Illical²

Affiliations

¹ Department of Orthopedic Surgery, Albert Einstein Medical Center, 5501 Old York Road, 19141 Philadelphia, PA, USA. Electronic address: merrillr@einstein.edu.
² Department of Orthopedic Surgery, Albert Einstein Medical Center, 5501 Old York Road, 19141 Philadelphia, PA, USA.
³ Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY USA.

PMID: 32070557
DOI: 10.1016/j.injury.2020.02.001

Abstract

Introduction: Open reduction with internal fixation (ORIF) and intramedullary nailing (IMN) have similar union rates for treating humerus shaft fractures, but IMN leads to increased incidence of shoulder impingement and reoperation. The difference in 30-day readmission rate and length of stay (LOS) between these procedures is unknown. The objective of the study was to compare 30-day unplanned readmissions and length of stay between humeral shaft fractures fixed with either ORIF or IMN.

Methods: The nationwide readmissions database (NRD) was queried for patients with humeral shaft fractures treated with ORIF or IMN between 2015-2016. IMN cases were propensity matched to ORIF cases based on demographic and co-morbid variables. Multivariable logistic regression determined if treatment modality was an independent risk factor for 30-day readmission or length of stay >3 days.

Results: There were 406 patients treated with IMN matched to 406 patients treated with ORIF. The 30-day readmission rate was 6.4% for IMN and 4.9% for ORIF (p = 0.45), and the median LOS was 3 days for each group (p = 0.45). Congestive heart failure (CHF)(OR=2.7, p = 0.04), depression (OR=3.3, p = 0.0008), and electrolyte abnormality (OR=3.6, p = 0.0003) were independent risk factors for readmission. Older age (OR=1.02, p = 0.03), CHF (OR=2.4, p = 0.03), electrolyte abnormality (OR=2.6, p = 0.0001), obesity (OR=2.8, p<0.0001), Medicaid (OR=2.1, p = 0.04), discharge to a facility (OR = 5.2, p<0.0001), discharge with home health services (OR=2.4, p = 0.0003), and open fracture (OR=2.3, p = 0.01) were independent risk factors for LOS >3 days. Procedure (ORIF vs. IMN) was not a predictor of 30-day readmission or LOS >3 days.

Conclusion: Comorbid conditions are risk factors for 30-day readmission and increased LOS. Comorbidity, discharge disposition, and open fractures are risk factors for increased LOS. Treating humeral shaft fractures with either ORIF or IMN did not affect readmission or length of stay.

Keywords: Humeral shaft fracture; Humerus; Humerus shaft fracture; Intramedullary rod; ORIF; Readmission.

Publication types

Comparative Study

MeSH terms

Aged
Aged, 80 and over
Databases, Factual
Female
Fracture Fixation, Intramedullary / methods*
Humans
Humeral Fractures / surgery*
Length of Stay / statistics & numerical data*
Logistic Models
Male
Middle Aged
Multivariate Analysis
Open Fracture Reduction / methods*
Patient Readmission / statistics & numerical data*
Time Factors
Treatment Outcome
United States