Analysis of 30-Day Postoperative Outcomes in Octogenarians Undergoing Open Reduction Internal Fixation for Distal Radius Fractures
Anna J Skochdopole, MS1, Sami P Tarabishy, MD1,2, Steven Hermiz, MD1,2, Brian A Mailey, MD3 and Fernando Herrera, MD1,2, (1)Medical University of South Carolina, Charleston, SC, (2)Ralph H Johnson Veterans Administration Medical Center, Charleston, SC, (3)Southern Illinois University School of Medicine, Springfield, IL
Distal radius fractures account for up to 18% of fractures in the geriatric population. Management of these patients remains heavily debated. The purpose of our study was to identify the influence of patient age ≥80 on 30-day postoperative outcomes while controlling for patient demographics and comorbidities.
Methods: The NSQIP database was queried for all patients having undergone open reduction internal fixation (ORIF) of distal radius fractures (DRF). CPT codes, 25607, 25608, 25609 between the years of 2007 to 2016 were included in our study. Patients were divided into 2 groups based on age; Group 1: 18-79 years; Group 2: 80 years and older. Patient demographics, preoperative, perioperative, and postoperative variables, and complications were recorded and analyzed.
Results: A total of 5894 patients were identified; Group 1 included 5,455 patients between 18-79 years, Group 2 consisted of 439 patients ≥80 years. Total complication rate was 2.6% for all patients, 2.5% for Group 1, and 3.9% for Group 2. The most common complication for both groups was UTI. Neither univariate nor multivariate analysis identified age ≥80 to be independently associated with an increased complication risk profile (OR 1.56, 95% CI [0.94 - 2.61], p=0.09 and OR 0.84, 95% CI [0.84 -1.52], p=0.56, respectively). Multivariate analysis demonstrated admission status, ASA classification, total operative time, bleeding disorder, and renal failure requiring dialysis to be independent predictors of 30-day complications across all patients undergoing ORIF for DRF.
Conclusion: Elderly patients undergoing ORIF of DRF do not have an overall higher complication rate compared to those younger than 80. Our data suggests that age alone is not an independent predictor of complication and older patients with an optimal risk profile should not be contraindicated from undergoing surgery for fixation of wrist fractures. Further, preoperative variables can serve as valuable predictors of complication for patient/family counseling and clinical decision-making regardless of age.
