Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures

Abstract

Introduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years). Materials and Methods: The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80). Multi-variate regression analyzes were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for baseline clinical characteristics and co-morbidity burdens. Results: A total of 19,585 patients were included: 5.3% were >80 years, 18.1% were 65-79 years, and 76.6% were <65 years. When compared to the non-geriatric population, individuals >80 years were at a significantly Abstract: higher risk of 30-day wound complications (OR 1.84; p = 0.019), pulmonary complications (OR 3.88; p < 0.001), renal complications (OR 1.96; p = 0.015), septic complications (OR 3.72; p = 0.002), urinary tract infections (OR 2.24; p < 0.001), bleeding requiring transfusion (OR 1.90; p = 0.025), mortality (or 7.44; p < 0.001), readmissions (OR 1.65; p = 0.004) and non-home discharge (OR 13.91; p < 0.001). Discussion: Octogenarians undergoing ankle fracture fixation are a high-risk population in need of significant pre-operative surgical and medical optimization. With the majority of patients undergoing non-elective ORIF procedures, it is critical to anticipate potential complications and incorporate experienced geriatric providers early in the surgical management of these patients. Conclusions: Octogenarians and nonagenarians are fundamentally distinct and vulnerable age groups with a high risk of complications, readmissions, mortality and non-home discharges compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Pre-operative counseling and risk-stratification are essential in this vulnerable patient population.

Extended length of stay and postoperative complications in octogenarians with hypertension following revision total knee arthroplasty

“…The authors found that patients aged 80 years and above had a higher risk of wound complications, pulmonary complications, and renal complications within 30-days compared to their younger counterparts following ORIF for ankle fractures. 24 Therefore, it is critical to explore potential differences in postoperative morbidity and mortality within the hypertensive geriatric population following various orthopaedic surgeries, such as revision TKA (rTKA). Thus, the purpose of this study was to analyze whether there are any differences in risk for thirty-day morbidity and mortality following rTKA in hypertensive octogenarians (aged 80e89 years) compared to their younger hypertensive geriatric counterparts (aged 65e79 years).…”

Risk factors and nomogram predictive model of surgical site infection in closed pilon fractures

“…However, the incidence of complications such as infection, nonunion, osteomyelitis, joint stiffness, and post-traumatic arthritis was still high. In 1999, Sirkin et [29]. Results of a retrospective study of patients with OTA/AO 43C tibial pilon fractures showed that increasing age (OR 1.02, P=0.040) was an independent predictor of deep infection [30].…”

Risk factors and nomogram predictive model of surgical site infection in closed pilon fractures

“…Meng et al and Spek et alfound that age was an independent predictor of postoperative surgical site infection in ankle fracture patients [ 27 , 28 ]. A comparative study of 19,585 patients with ankle fractures showed that 30-day wound complications were significantly increased in individuals > 80 years (OR 1.84; P = 0.019) [ 29 ]. Results of a retrospective study of patients with OTA/AO 43C tibial pilon fractures showed that increasing age (OR 1.02, P = 0.040) was an independent predictor of deep infection [ 30 ].…”