N. N. Branch1, R. Wilson1 1Howard University College Of Medicine,Washington, DC, USA
Introduction: Elderly patients are an increasing proportion of the population. Perioperative outcomes of elderly patients who sustain open tibia fractures may be affected by a variety of factors including nutritional status, bone quality, comorbid conditions and gender. Therefore, we aim to determine the 30 day perioperative complications associated with open reduction and internal fixation (ORIF) of open tibia fractures in the elderly.
Methods: A retrospective analysis of the National Trauma Data Bank (NTDB) from 2007-2010 utilizing ICD-9 codes (823.10, 823.30, and 823.90) was conducted. Cases >18 years old, who underwent open reduction and internal fixation of the tibia at a level I or level II trauma center were included. Patients were then stratified by age into four groups, with those 18-24 years serving as the reference group and the elderly being those 65 years and older.
Results: 9,331 open tibia fractures during the study period underwent ORIF, of which 7,201 cases met inclusion criteria. The majority were white (67%), males (74%), between 25-44 years old (42%). Patients with private insurance (23%) and injury via motor vehicle collisions (25%) were most common. Elderly patients comprised 9.3% of the total population of which 86% were White and 52% were male. Elderly patients were 78% more likely to have fixation after hospital day 2 (OR: 1.78 CI: 1.52-32.08 p<0.001), 2.5 times more likely to have a bleeding complication (OR: 2.5 CI: 1.13-5.54 p=0.024), and almost 5 times more likely to have cardiac arrest within 30 days (OR: 4.93 CI: 1.04-23.46 p=0.045). Developing superficial (OR: 3.91 CI: 1.14-13.5 p=0.031), organ/space (OR: 1.75 CI: 1.19-2.59 p=0.005), or any surgical site infection (OR: 1.95 CI: 1.35-2.84 p<0.001) were more likely in the elderly compared to those ages 18-24 years. A greater proportion of the elderly developed systemic sepsis (χ2= 34.7 N = 9.95 p=0.019). Elderly patients were 72% more likely to have at least one perioperative complication (OR: 1.72 CI: 1.27-2.35 p=0.001), and 26% more likely to have a longer length of stay (OR: 1.26 CI: 1.18-1.36 p<0.001). Elderly patients were six times more likely to die (OR: 6.05 CI: 2.07-17.69 p<0.001).
Conclusion: Elderly patients represent a small proportion of isolated traumatic open tibia fracture cases with a slight majority being among elderly men. There is a clear disparity in their preoperative surgical outcomes, having greater odds of developing perioperative infections or any complication. Elderly patients who sustain open tibia fractures were subject to having the most profound perioperative complication of all; death. This may be secondary to their markedly increased odds of perioperative cardiac arrest, which prolonged length of hospitalization. Additional research is warranted to determine this patient population’s long-term postoperative functional status and complications of interest such as nonunion and malunion.