Objectives: To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture.
Design: Retrospective database review.
Setting: The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States.
Patients/participants: NSQIP patients over 65 years of age with patella fractures.
Intervention: Surgical fixation of patella fracture including extensor mechanism repair.
Main outcome measurements: Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications.
Results: 1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V.
Conclusions: Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes.
Level of evidence: Prognostic level III.
Keywords: fragility fractures; geriatric medicine; geriatric trauma; hospitalist; ocupational therapy; patella fractures; physical medicine and rehabilitation; physical therapy; trauma surgery.
© The Author(s) 2021.