Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures |
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| Affiliation: | 1. Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, 888 Old Country Road, Plainview, New York, 11803, USA;2. Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Long Island Jewish Hospital, Northwell Health, Great Neck, NY, 11021, USA;3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Southside Hospital, Northwell Health, 217 East Main Street, Bayshore, NY, 11706, USA;1. Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India;2. Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India;3. Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Germany;4. Orthopaedic Surgery, Manipal Hospitals, Bangalore, India;5. Institute of Orthopedic Surgery, Max Super Speciality Hospital, Mohali, India;1. Hi-Tech Medical College, Pandara, Bhubaneswar, Odisha, 751025, India;2. Pelvic and Acetabular Reconstruction Unit, Southmead Hospital, Bristol, BS10 5NB, UK;3. Sardar Vallabhbhai Patel Institute of Medical Sciences and Research Hospital, Smt. NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, 380006, India;1. Krishna Institute of Medical Sciences, Hyderabad, India;2. Orthopaedics, ESIC Medical College, Hyderabad, India;1. North Bristol NHS Trust, UK;2. Cairo University, Egypt;1. R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA;2. Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA;1. All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, 110029, India;2. All India Institute of Medical Sciences, Jai Prakash Narayan Apex Trauma Centre, Ansari Nagar, New Delhi, Delhi, 110029, India |
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| Abstract: | ![]()
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. |
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