Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures

BackgroundOpen pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality.MethodsA query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher’s exact test and chi-square test for categorical variables, and Welch’s t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications.ResultsA total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality.ConclusionWe report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population.Level of EvidenceLevel II, Retrospective study.     

Surgical management of pelvic organ prolapse

Pelvic organ prolapse is a common condition which can have a profound effect on health-related quality of life. The lifetime risk of surgery for pelvic organ prolapse for all women is around 10–12%, making prolapse surgery one of the most commonly performed operations of all. Surgery is generally offered only to women to do not respond to conservative measures such as physiotherapy and/or vaginal pessaries. It is very important to ensure excellent clinical governance around the decision-making process for this elective surgical problem, and this may include the use of written information, face to face and telephone consultations, patient reported outcome measures and patient decision aids. This chapter will cover all the different techniques for prolapse surgery including conventional approaches using native tissue, uterus conserving prolapse surgery and surgery for post-hysterectomy vault prolapse. This will also include laparoscopic prolapse surgery. The role of mesh in prolapse surgery will also be discussed and this chapter will cover important topics including patient selection and preparation for prolapse surgery, shared decision making and how best to facilitate this, patient preparation before prolapse surgery and follow-up post operation.