D. Metcalfe1, A. Haider1, O. A. Olufajo1, M. B. Harris2, C. K. Zogg1, A. J. Rios Diaz1, M. J. Weaver2, A. Salim1 1Harvard Medical School,Center For Surgery And Public Health,Boston, MA, USA 2Brigham & Women’s Hospital,Department Of Orthopedic Surgery,Boston, MA, USA
Introduction:
Acute compartment syndrome (CS) is an important diagnosis for general, vascular, orthopedic, and trauma surgeons. However, only single center studies have previously described the epidemiology of CS; and the long-term outcomes for these patients have yet to be reported. In this study, we sought to describe the epidemiology of CS and the rate of subsequent limb loss using a comprehensive statewide inpatient database.
Methods:
All CS diagnoses (ICD-9-CM 729.7* and 958.9*) were extracted from the California State Inpatient Database (2007-2011), which is an all-payer dataset that captures 98% of hospital admissions. The SID was linked to the AHA Annual Survey Database to include hospital-level characteristics and the US census (2010) provided a population denominator. Patients were tracked longitudinally using a unique identifier within the SID to identify 30-day readmissions to any hospital in California and subsequent need for amputation within 12 months. Multivariable logistic regression was used to identify independent risk factors for amputation. The covariates within this model were age, race, sex, payer status, Charlson Comorbidity Index, Injury Severity Score, lower/upper limb, weekend admission, trauma center designation, hospital bed size, and teaching hospital status.
Results:
There were 6,471 CS cases – 1,294 per year, or an annual incidence of 3.5 per 100,000 population. The mean age was 46.2 (SD 20.0). Patients were predominantly male (73.6%), white (58.6%), publicly insured (41.1%), and admitted to either a level 1 (44.1%) or level 2 trauma center (46.8%). Most cases (61.0%) were secondary to trauma and the majority of these (63.5%) were associated with fracture. Both traumatic and non-traumatic CS predominantly affected the lower limb (71.3% and 72.1% respectively).
3,119 (48.2%) of patients suffered complications, 325 (5.0%) died, 670 (10.4%) required unplanned re-admission within 30 days, and 95 (1.5%) required a major amputation within 12 months of discharge. Most amputations (87.4%) occurred during subsequent admissions and not during the acute hospitalization. Significant independent risk factors for major amputation were lower limb CS (OR 9.0, 95% CI 3.29-24.7) and a non-traumatic cause (OR 4.72, 95% CI 2.6-8.7).
Conclusion:
CS is an infrequent but potentially devastating diagnosis that can lead to limb loss. There are significant long-term sequelae with the majority of amputations becoming necessary after discharge from hospital.