N. N. Branch1,2, A. Obirieze2, R. H. Wilson1,2 1Howard University College Of Medicine,Washington, DC, USA 2Howard University Hospital,Surgery,Washington, DC, USA
Introduction: Patients with open humerus fractures are often subjected to high velocity forces. Consequently, they may present with an isolated injury or polytrauma, requiring prioritization of fracture management with the need to stabilize more immediate life threatening injuries. The extent of these injuries may intuitively correlate with outcomes, however, not all patients will undergo definitive fixation during their hospitalization. As such we sought to determine the relationship between Injury Severity Score (ISS) and perioperative complications after open reduction and internal fixation (ORIF) of traumatic open humerus fractures.
Methods: A retrospective analysis of the National Trauma Data Bank from 2007-2010 utilizing ICD-9 codes was conducted. Patients >18 years old, who underwent open reduction and internal fixation (ORIF) of the humerus at a level I or level II trauma center were included. Using multivariate analyses covariates were controlled for including but not limited to obesity, congestive heart failure, diabetes, bleeding disorders, age, steroid use, and smoking status. Univariate and bivariate analyses were also performed. ISS was stratified into four groups, 1: <16, 2: 16-24, 3: 25-75, and 4: unknown with ISS <16 serving as the reference group.
Results:A total of 5,663 patients met the inclusion criteria. The majority of whom were white (65%) males (71%) ages 25-44 (39%) with private insurance (26%) whose fracture resulted from blunt trauma secondary a motor vehicle collision (26%). The average hospital length of stay was 11.8 days with a mean of 3.5 days in the intensive care unit. 59% of patients had an ISS of <16. On multivariate analysis with increasing ISS (group 2 and 3) increased the odds of developing an organ/space surgical site infection (SSI), sepsis, or any infection (Table 1). Further, the odds of having any perioperative complication in addition to death within 30 days of admission increased with increasing ISS (Table 1). Superficial SSI was increased by almost five times for ISS group 3 (OR: 4.73 CI: 2.3-9.2 p<0.001), and deep SSI were increased more than seven times for ISS group 2 (OR: 7.68 CI: 1.31-45.14 p=0.024) compared to an ISS of <16.
Conclusion: Injury Severity Score is an accurate predictor of perioperative complications associated with ORIF of traumatic open fractures of the humerus. This is particularly true of infectious complications and mortality. In general with increasing ISS there is an increase in the odds of developing a perioperative complication.
