Risk Factors for 30-Day Complications and Unplanned Reoperation Following Surgical Treatment of Distal Radius Fractures

Abstract

Background: The purpose of this study was to identify demographic data, medical comorbidities, and perioperative factors that are associated with increased risk of overall surgical complications, wound complications, and reoperation within 30 days of open reduction and internal fixation (ORIF) of distal radius fractures. Methods: All adult patients undergoing ORIF of distal radius fractures in the National Surgical Quality Improvement Program database between 2005 and 2020 were identified. Patients were excluded for secondary procedures, open/infected injuries, or inpatient surgical setting. Demographic data, medical comorbidities, and perioperative data were examined for each patient, and patients were grouped by the presence or absence of any surgical complication. Univariate analysis and multivariate logistic regression were used to identify risk factors. Results: A total of 20 301 patients from between 2005 and 2020 met the inclusion criteria, of which 219 complications (1.1% of cases) were identified. Following multivariate analysis, independent risk factors found to be associated with surgical complications included male sex, smoking, heart failure, longer operative time, and American Society of Anesthesiologists (ASA) classification of 3 or higher. Conclusion: Male sex, smoking, heart failure, prolonged operative time, and ASA status of 3 or higher are associated with an increased risk of surgical complications following ORIF of distal radius fractures. These complications, with the exception of heart failure, were also associated with an increased risk of wound complications. Finally, male sex, nonwhite race, smoking, dialysis, prolonged operative time, and 3 or higher ASA class were associated with reoperations. Understanding these risk factors allows surgeons to better predict and prevent complications in high-risk populations.

Risk Factors for 30-Day Unplanned Re-Operation in Pediatric Upper Extremity Surgery: A National Surgical Quality Improvement Program (NSQIP)-Pediatric Analysis

“…ASA classification III-V was the greatest independent predictor of unplanned re-operation. Higher ASA classification is known to be associated with increased re-operation rates in prior studies in the orthopedic literature [ 21 , 22 ]. The ASA classification has been used since the 1940s to provide a categorization of operative risk; however, there are limitations including low inter-reporter reliability, vague criteria, and simplicity [ 23 ].…”

Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

“…43,49 Dialysis dependency has been associated with greater risk of in-hospital mortality, longer postoperative stay, and reoperations. 44,45 Chronic steroid use has been associated with increased risk for major, minor, and infectious complications in patients undergoing various orthopaedic procedures. 41,42 By controlling for smoking, dialysis, bleeding disorders, obesity, and steroid use in our binomial logistic regression, we have decreased the potential of confounding variables to affect the independent association between mFI-5 and 30-day complications in our patient cohort.…”

“…Our study identified smoking, steroid use, bleeding disorders, dialysis, and obesity as the most pertinent risk factors for poor outcomes of fracture fixation procedures and bone healing. [40][41][42][43][44][45] Smoking has been associated with surgical site infections, postoperative wound complications, and reoperations after fracture fixation. [46][47][48] Bleeding disorders have been associated with increased risk of major postoperative complications and need for postoperative blood transfusion.…”