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Risk Factors for Infection After Distal Radius Fracture Fixation: Analysis of a National Database and Impact on Cost of Care
Ryan S Constantine, MD1, Elliot L.H. Le, MD, MBA2, Michael B Gehring, MD3, Lucas Ohmes, MD1 and Matthew L. Iorio, MD4, (1)University of Colorado, Aurora, CO, (2)University of Colorado School of Medicine, Aurora, NC, (3)University of Colorado, Denver, CO, (4)University of Colorado, Anschutz Medical Center, Aurora, CO

Introduction
Although a relatively rare complication, infection after distal radius fracture fixation can be a devastating complication leading to potential hardware removal, prolonged antibiotic course, multiple office visits, and increased overall cost.This study aims to identify potential risk factors for infectious complications after distal radius fracture fixation and assess the impact on overall cost within a large national database.
Materials and Methods
This study utilized the PearlDiver national database encompassing 53 million unique patients from 1/1/2010 - 3/31/2020. The cohort included patients undergoing distal radius fracture fixation (CPT 25606 - 25609). The end point is post-operative infection within 180 days of fixation. Two-sample T-test compared rates of infection between open and percutaneous fracture fixation techniques. Logistic regression analysis was utilized to define independent risk factors for developing post-operative infection. .A propensity matched cohort was created on patient age, gender, and open fracture. Logistic regression analysis of the propensity matched cohorts assessed risk factors for developing post-operative infection. Cost of care related to distal radius fracture fixation was assessed and T-test utilized to compare cost of care of no infection vs infection.
Results
The database included 87,169 patients who underwent distal radius fracture fixation (Table 1). Post-operative infection was identified in 781 patients (0.9%). There was a significant difference in post-operative infection with percutaneous fixation (1.3%) vs open fixation (0.8%) (p<0.005). Logistic regression analysis identified male gender, open fracture, lung disease, CKD, diabetes, hypertension, liver disease, obesity, and tobacco use to be independent risk factors for developing post-operative infection (Table 2). Logistic regression analysis of propensity matched cohorts demonstrated that tobacco use as a significant risk factor (Table 3). Average cost of care for patients undergoing fracture fixation without infection was $6,383 against $23,355 for those with infection, which was significantly different (p = <0.005).
Conclusions
Multiple risk factors for post-operative infection are identified. Cost is significantly increased after post-operative infection by almost four-fold. Attempts to correct or optimize modifiable risk factors may lead to substantial cost savings and improved outcomes for patients.



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