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Impact of Time-to-Surgery on Adverse Outcomes for Distal Radius Fractures: A Population-Based Study
Jonathan Persitz, M.D.
1, Heather L. Baltzer, MD
2, Andrew Calzavara, MSc
3, Jesse Wolfstadt, MD, MSc, FRCSC
4, Ryan Paul, MD
5, Andrea HW Chan, MD, MA, FRCSC
6, Samantha Lee, MSc
3, Brandon Zagorski, MSc
3; David R Urbach, MD, MSc, FRCSC, FACS
7(1)University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, (2)University Health Network, Toronto, ON, Canada, (3)ICES, Toronto, ON, Canada, (4)Mount Sinai Hospital, Toronto, ON, Canada, (5)Toronto Western Hospital, Toronto, ON, Canada, (6)Hospital for SickKids, Toronto, ON, Canada, (7)University of Toronto and Institute of Health, Policy, Management and Evaluation, Toronto, ON, Canada
ObjectiveThe timing of surgical fixation for acute distal radius fractures (DRFs) may influence postoperative outcomes, yet the optimal surgical window remains unclear. This study aimed to determine the optimal time window for surgical fixation for acute, isolated DRF, to minimize postoperative complications.
Patients/MethodsThis population-based study analyzed Ontario administrative health data from 2010 to 2020, including 13,389 adults who underwent surgical fixation for acute, isolated DRF. Patients with open fractures, polytrauma, neurovascular injuries, or other complicating factors were excluded. Wait time was analyzed as a continuous variable and defined as days from emergency department presentation to operative intervention. Primary outcome was a composite of complications: infection, revision, and hardware removal surgeries. Secondary outcomes were post-operative infection and revision. Confounding by indication was addressed using institutional-level wait times as an instrumental variable. Time-to-event Cox multivariable models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for demographics, comorbidities, fracture type (intra- vs. extra-articular), fixation type, surgeon volume, and hospital type (teaching vs. non-teaching).
ResultsPatients treated within 6-20 days had a 20% lower risk of composite complications compared to those treated within 0-2 days (HR 0.80, 95% CI: 0.71-0.90, P=0.001). Infection risk was also 39% lower when surgery occurred within 6-15 days (HR 0.61, 95% CI: 0.46-0.81, P=0.001).
At the institutional level, treatment within 6-15 days was associated with a 30% lower infection risk compared to 1-5 days (HR 0.70, 95% CI: 0.56-0.87,
P=0.002). Surgeries beyond 25 days showed a non-significant trend toward worse outcomes (HR 1.10, 95% CI: 0.75-1.32,
P=0.88).
ConclusionSurgical fixation of distal radius fractures within 6-15 days was associated with the lowest observed rates of composite complications and infection. These findings suggest that this timeframe may represent an optimal window for intervention. By evaluating multiple discrete time points, this study contributes to the understanding of "when to operate," complementing prior literature focused primarily on delayed surgery.
Level of Evidence: III
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