Predicting early term complications of ORIF distal radius fracture in outpatient settings using NSQIP data

Ruth Luttwak; Taylor J Ibelli; Peter J Taub; Eitan Melamed; Itay Wiser

doi:10.1016/j.injury.2023.04.008

Predicting early term complications of ORIF distal radius fracture in outpatient settings using NSQIP data

Injury. 2023 Apr 13:S0020-1383(23)00353-4. doi: 10.1016/j.injury.2023.04.008. Online ahead of print.

Authors

Ruth Luttwak¹, Taylor J Ibelli², Peter J Taub³, Eitan Melamed⁴, Itay Wiser⁵

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Elmhurst Hospital Center, New York, New York, USA; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: luttwakr@nychhc.org.
² Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: peter.taub@mountsinai.org.
⁴ Division of Plastic and Reconstructive Surgery, Elmhurst Hospital Center, New York, New York, USA; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: melamede2@nychhc.org.
⁵ Division of Plastic and Reconstructive Surgery, Elmhurst Hospital Center, New York, New York, USA; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: wiseri@nychhc.org.

PMID: 37095046
DOI: 10.1016/j.injury.2023.04.008

Abstract

Purpose: There is no consensus on which risk factors are most predictive for complications following open reduction internal fixation of distal radius fractures (ORIF-DRF) in an outpatient setting. This study is a complication risk analysis for ORIF-DRF in outpatient settings based on data obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).

Methods: A nested, case-control study, was conducted in ORIF-DRF cases performed in outpatient settings from 2013 to 2019 obtained from the ACS-NSQIP database. Cases with documented local or systemic complications were age and gender-matched in a 1:3 ratio. The association between patient and procedure-dependent risk factors for systemic and local complications in general and for different subpopulations was examined. Bivariate and multivariable analyses were performed to evaluate the association between risk factors and complications.

Results: From a total of 18,324 ORIF-DRF, 349 cases with complications were identified and matched to 1047 Controls. Independent patient-related risk factors included a history of smoking, the American Society of Anesthesiologists (ASA) Physical Status Classification 3 and 4, and bleeding disorder. The intra-articular fracture with three or more fragments was found to be an independent risk factor of all procedure-related risk factors. History of smoking was found to be an independent risk factor for all gender populations, as well as for patients younger the 65 years old. For older patients (age ≥65) bleeding disorder was found to be an independent risk factor.

Conclusion: Complications of ORIF-DRF in outpatient settings have many risk factors. This study provides surgeons with specific risk factors for possible complications following ORIF-DRF.

Keywords: Complications; ORIF distal radius; Outpatients; Risk factors; Smoking.