Early Outcomes After Surgical Management of Geriatric Patella Fractures

Abstract

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.

Recommendations from the ICM-VTE: Trauma

“…The authors concluded that the VTE rates from 2008 to 2016 have remained relatively unchanged and that thromboembolic guidelines should be reassessed. Likewise, Kapilow et al 335 , also published a retrospective review using NSQIP that reported the early outcomes after surgical management of isolated patellar fractures in a population of 1,721 patients 65 years of age or older. Overall, only 13 (0.8%) of these patients developed VTE, but the authors noted that this patient cohort was at higher risk for prolonged hospitalization, discharge to a facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days.…”

“…The large cohort studies utilizing the NSQIP database did not control for the routine use of VTE prophylaxis; however, much lower rates of VTE between 0.8 - 0.9% were noted 327,335 . Unfortunately, the NSQIP database does not include VTE prophylaxis, so it is unclear if a prophylaxis was utilized, and if so, what specific type of VTE prophylaxis was used.…”

High risk of complications following surgical treatment of patella fractures — a cross-sectional study of 798 patients with mean 6.4 years follow-up

“…The overall reoperation rate following surgical treatment of patella fractures has been reported to be 34% [ 12 ]. Increasing co-morbidity is reported to increase the risk of postoperative complications [ 21 , 22 ].…”